Strategic UM & Admissions Analytics Leader

Socket.dev; Gainesville (FL); On-site; USD 110,000 - 170,000; Full time

Job summary

UF Health seeks a Manager of UM & Admissions Analysis to lead operational and analytical functions for admission status accuracy, medical necessity compliance, and revenue optimization across the enterprise. You will oversee review workflows, analytics, and performance monitoring for inpatient, observation, and outpatient populations.

The role requires RN licensure with 5+ years in utilization or case management, revenue cycle, or payer relations, plus 3+ years of leadership.

Qualifications

• Bachelor’s degree in nursing required.
• Master’s degree in nursing, Healthcare Administration, Public Health, Business Administration, or related field preferred.
• Registered RN required.
• ACM, CCM, CPHQ, HCQM, CPUR, CRCR certifications preferred.
• Lean/Six Sigma preferred.

Responsibilities

• Experience with admission status reviews, medical necessity determination, and payer regulations.
• Experience working with Medicare, Medicaid, and commercial payers.
• Experience with complex health system or academic medical centers is strongly preferred.
• Experience with physician advisor programs.
• Epic experience a must.
• Ability to interpret regulatory requirements and translate them into operational processes.
• Ability to manage multiple priorities and lead through organizational change.

Education

Bachelor’s degree in nursing

Master’s degree in nursing, Healthcare Administration, Public Health, Business Administration, or related field preferred

Registered RN required

Accredited Case Manager (ACM) preferred

Certified Case Manager (CCM) preferred

Certified Professional in Healthcare Quality (CPHQ) preferred

Certification in Healthcare Quality and Management (HCQM) preferred

Certified Professional in Utilization Review (CPUR) preferred

Lean/Six Sigma preferred

Certified Revenue Cycle Representative (CRCR) preferred

Job description

UF Health seeks a Manager of UM & Admissions Analysis to lead operational and analytical functions for admission status accuracy, medical necessity compliance, and revenue optimization across the enterprise. You will oversee review workflows, analytics, and performance monitoring for inpatient, observation, and outpatient populations.

The role requires RN licensure with 5+ years in utilization or case management, revenue cycle, or payer relations, plus 3+ years of leadership.