Strategic Utilization Review Manager

UF Health; Gainesville (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

UF Health seeks a Manager of Utilization Review to provide operational leadership across the health system. You will ensure clinical appropriateness of patient status determinations and regulatory compliance, leading UR Specialists and Nurses and partnering with physicians, revenue cycle, and payer teams.

The role drives standardized utilization management processes, supports MOON notifications and admission status accuracy, and aims to optimize reimbursement while reducing denials.

Qualifications

• RN licensure required.
• Minimum five years in Utilization Management, Case Management, Revenue Cycle, or Denials Management.
• Minimum three years of leadership experience in hospital UM operations.

Responsibilities

• Provide operational leadership for utilization review activities across the health system.
• Ensure clinical appropriateness of patient status determinations and regulatory compliance.
• Lead a team of UR Specialists and Nurses and collaborate with physician advisors and payer relations.
• Develop standardized utilization management processes across facilities.
• Support MOON notifications, admission status accuracy, and denial-prevention strategies.

Education

Bachelor’s degree in nursing

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

Tools

Epic

Job description

UF Health seeks a Manager of Utilization Review to provide operational leadership across the health system. You will ensure clinical appropriateness of patient status determinations and regulatory compliance, leading UR Specialists and Nurses and partnering with physicians, revenue cycle, and payer teams.

The role drives standardized utilization management processes, supports MOON notifications and admission status accuracy, and aims to optimize reimbursement while reducing denials.