Utilization Management & Revenue Cycle Lead

Impact Advisors; Alton (IL); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Annual performance bonus

Job summary

Impact Advisors is seeking an Utilization Review/Utilization Management Lead to oversee the UM program for a healthcare client. You will work with clinical, case management, revenue cycle, and physician leadership to improve review productivity and outcomes.

The role emphasizes operational leadership, performance management, and process improvement to align with payer and regulatory requirements and reduce denials.

Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Business Administration, Public Health, or related field.
• Master's degree in Healthcare Administration (MHA), Business Administration (MBA), Public Health (MPH), Nursing, or related field.

Responsibilities

• Lead operational assessments of utilization management, case management, patient throughput, and care coordination.
• Evaluate current-state workflows, staffing models, and performance metrics.
• Design and implement scalable improvements to increase efficiency and service delivery.
• Direct daily UM operations, including work distribution and escalation.
• Promote consistent application of medical-necessity criteria and appropriate level-of-care status.
• Manage physician-advisor referral and secondary-review processes.
• Oversee optimization of prior authorization, concurrent and retrospective reviews, and appeals.

Skills

Analytical skills

Project management

Stakeholder engagement

Leadership

Education

Bachelor's degree

Master's degree

Tools

InterQual

MCG

Epic

Cerner

Job description

Impact Advisors is seeking an Utilization Review/Utilization Management Lead to oversee the UM program for a healthcare client. You will work with clinical, case management, revenue cycle, and physician leadership to improve review productivity and outcomes.

The role emphasizes operational leadership, performance management, and process improvement to align with payer and regulatory requirements and reduce denials.