Senior Utilization Management Lead - Denials & Process Improvement

WVU Medicine; Morgantown (WV); On-site; USD 95,000 - 135,000; Full time

Job summary

West Virginia University Health System is seeking a Lead Utilization Management Coordinator (UMC) to guide clinical and operational denials management, drive process improvements, and mentor UR staff. This role blends nursing expertise with revenue cycle leadership to secure timely authorizations and optimize reimbursement.

The position requires RN licensure, hospital-based experience, and strong knowledge of UM, payor behaviors, and clinical appeals.

Qualifications

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state license through eNLC.
• Four (4) years clinical hospital experience.
• Five (5) years Utilization Review/Clinical Appeals experience.
• Bachelor’s Degree in Nursing preferred.

Responsibilities

• Coach and mentor staff; identify skill gaps and provide feedback.
• Oversee day-to-day operations to ensure deadlines are met.
• Track KPIs and report performance to leadership.
• Coordinate with UR coordinators, clinical appeals, and physician advisors to prevent/resolve denials.
• Assist in education and process improvements for staff.

Skills

RN leadership

Utilization management

Mentoring

Process improvement

KPI tracking

Education

Registered Nurse license (state)

Bachelor’s Degree in Nursing

Job description

West Virginia University Health System is seeking a Lead Utilization Management Coordinator (UMC) to guide clinical and operational denials management, drive process improvements, and mentor UR staff. This role blends nursing expertise with revenue cycle leadership to secure timely authorizations and optimize reimbursement.

The position requires RN licensure, hospital-based experience, and strong knowledge of UM, payor behaviors, and clinical appeals.