Utilization Review & Clinical Operations Manager

Malvern Health; Philadelphia (Philadelphia County); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Paid Time Off

401K plan with company match

On-site meals

Job summary

Malvern Health is seeking a full-time Utilization Review Manager to lead a growing UM department in our new building at 3905 Ford Road. You will supervise treatment engagement specialists and partner with the clinical team to secure certifications and manage authorizations for psychiatric and residential programs.

The role requires a master's degree in nursing and PA licensure, with prior utilization review experience preferred.

Qualifications

• Master's Degree in Nursing and PA license required or strongly preferred.
• Previous utilization review experience is preferred.
• Strong communication, teamwork and problem-solving abilities.
• Proficiency with Microsoft Office and billing systems.

Responsibilities

• Oversee daily operations of the Treatment Engagement specialists and assign caseloads.
• Coordinate between clinical and UM teams to ensure accurate level of care.
• Manage reviews, appeals and denial logs; perform concurrent reviews.
• Educate staff on Medical Necessity criteria and payor requirements.
• Maintain documentation logs and communicate with payers and teams.

Skills

Utilization review

Communication skills

Billing experience

Microsoft Office

Education

Master's degree in nursing

PA nursing license

Tools

Billing software

EMR systems

Job description

Malvern Health is seeking a full-time Utilization Review Manager to lead a growing UM department in our new building at 3905 Ford Road. You will supervise treatment engagement specialists and partner with the clinical team to secure certifications and manage authorizations for psychiatric and residential programs.

The role requires a master's degree in nursing and PA licensure, with prior utilization review experience preferred.