Utilization Management Lead: Revenue Cycle Optimization

Impact Advisors; United States; À distance; USD 130 000 - 180 000; Plein temps

Avantages offerts par ce poste

Annual performance bonus

Résumé du poste

Impact Advisors, LLC in the United States is seeking a Utilization Review/Utilization Management Lead to oversee day-to-day UM program operations for a healthcare client. You will drive concurrent review, admissions status decisions, and appeals, aligning with payer and regulatory requirements.

Collaborate with clinical, revenue cycle, and leadership teams to optimize throughput and reduce denials. The role emphasizes operational leadership, data-driven improvements, and implementation of UM

Qualifications

• Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Public Health, or a related field.
• 7+ years of experience in healthcare operations, utilization management, care management, revenue cycle, or performance improvement.
• 3+ years of leadership experience managing operational teams, transformation initiatives, or consulting engagements.
• Strong analytical, project management, and stakeholder engagement skills; able to manage competing priorities.

Responsabilités

• Lead operational assessments of utilization management, case management, patient throughput, and care coordination functions.
• Evaluate current-state workflows, organizational structures, staffing models, and performance metrics.
• Design and implement scalable operational improvements that increase efficiency and improve service delivery.
• Implement operational improvements that increase review efficiency, consistency, and service delivery.
• Partner with client operational leaders and teams to prioritize UM initiatives that improve performance.
• Direct daily UM operations, including work distribution, review prioritization, escalation, and coverage.
• Promote consistent application of medical-necessity criteria and appropriate level-of-care status.
• Manage physician-advisor referral and secondary-review processes for cases that do not meet criteria.
• Oversee optimization of prior authorization, concurrent review, retrospective review, and appeals workflows.
• Analyze utilization patterns and operational performance to identify opportunities for improvement.
• Improve turnaround times, productivity, and service-level agreement performance.
• Support implementation of utilization management technologies, automation tools, and workflow enhancements.
• Establish operational standards and key performance indicators for ongoing monitoring and accountability.
• Collaborate with revenue cycle, patient access, and clinical operations leaders to reduce authorization-related denials.
• Improve alignment between utilization management, clinical documentation, case management, and revenue cycle functions.
• Develop operational strategies that support reimbursement optimization and financial performance.
• Analyze denial trends and implement corrective action plans to reduce preventable revenue leakage.
• Support initiatives focused on medical necessity documentation and payer compliance.
• Partner with case management and patient-flow leaders on length of stay, discharge barriers, and avoidable days tied to utilization decisions.
• Identify UM-related barriers to care progression and status determination.
• Establish dashboards and reporting tools to monitor throughput performance and operational outcomes.
• Lead targeted operational improvement initiatives within the client UM program.
• Utilize Lean, Six Sigma, or other performance improvement methodologies to redesign workflows.
• Facilitate stakeholder engagement sessions, process mapping workshops, and change management activities.
• Implement performance management frameworks focused on measurable outcomes and continuous improvement.
• Analyze operational, financial, and utilization data to identify trends and improvement opportunities.
• Develop executive-level dashboards, scorecards, and performance reports.
• Monitor productivity, turnaround times, denial rates, length of stay, and resource utilization metrics.
• Present findings and recommendations to client operational leaders.
• Translate complex data into actionable operational strategies.
• Provide functional leadership to UM team.
• Coach staff on criteria use, documentation, escalation, and productivity expectations.
• Contribute to playbooks, training, and standard work for the UM program.
• Support business development efforts, including proposal development and client presentations.

Connaissances

Analytical skills

Project management

Stakeholder engagement

Formation

Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Public Health, or related field

Description du poste

Impact Advisors, LLC in the United States is seeking a Utilization Review/Utilization Management Lead to oversee day-to-day UM program operations for a healthcare client. You will drive concurrent review, admissions status decisions, and appeals, aligning with payer and regulatory requirements.

Collaborate with clinical, revenue cycle, and leadership teams to optimize throughput and reduce denials. The role emphasizes operational leadership, data-driven improvements, and implementation of UM