Utilization Management Lead - Revenue Cycle & Throughput

Impact Advisors; Northern (KY); On-site; USD 110,000 - 150,000; Full time

Job summary

Impact Advisors is seeking a Utilization Review / Utilization Management Lead to oversee the UM program for a healthcare client in the U.S. This role focuses on concurrent, prior authorization, retrospective reviews, and appeals, ensuring timely, criteria-based decisions aligned with payer and regulatory requirements.

The role partners with clinical, revenue cycle, and physician leadership to drive productivity, reduce denials, and support throughput goals through operational leadership and

Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Business Administration, Public Health, or 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 understanding of utilization management operations, patient throughput, care coordination, and healthcare reimbursement.

Responsibilities

• Lead operational assessments of utilization management, case management, patient throughput, and care coordination functions.
• 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.

Skills

Leadership

Stakeholder engagement

Project management

Analytical skills

Lean Six Sigma

Healthcare reimbursement

Education

Bachelor's degree in Healthcare Administration

Nursing or related field

Tools

InterQual

MCG

Epic

Cerner

Job description

Impact Advisors is seeking a Utilization Review / Utilization Management Lead to oversee the UM program for a healthcare client in the U.S. This role focuses on concurrent, prior authorization, retrospective reviews, and appeals, ensuring timely, criteria-based decisions aligned with payer and regulatory requirements.

The role partners with clinical, revenue cycle, and physician leadership to drive productivity, reduce denials, and support throughput goals through operational leadership and