Utilization Review Nurse Manager

Massachusetts Health & Hospital Association; Washington (District of Columbia); On-site; USD 120,000 - 180,000; Full time

Job summary

Massachusetts Health & Hospital Association is seeking an experienced Utilization Management Team Lead to oversee clinical reviews, discharge planning, and the analysis of utilization data in support of high-quality patient care.

You will coordinate with clinical teams, providers, and internal partners to ensure regulatory compliance and effective service delivery, while guiding staff hiring, training, and professional development to strengthen utilization management across the organization.

Qualifications

• Experience leading utilization management teams and initiatives.
• Experience in clinical review processes and utilization management.
• Strong analytical skills to interpret utilization data.
• Knowledge of healthcare regulations and compliance standards.
• Effective communication and collaboration with diverse healthcare professionals.

Responsibilities

• Oversee clinical reviews to assess medical necessity and appropriateness of care.
• Manage discharge planning processes to ensure effective patient transitions.
• Analyze utilization reports to monitor and improve service efficiency.
• Support staff hiring, training, and professional development initiatives.
• Ensure regulatory compliance across all utilization management activities.
• Coordinate with clinical teams, providers, and internal partners to enhance care outcomes and service quality.

Skills

Leadership

Team management

Clinical review

Utilization management

Analytical skills

Healthcare regulations

Communication

Job description

• Oversee clinical reviews to assess medical necessity and appropriateness of care.
• Manage discharge planning processes to ensure effective patient transitions.
• Analyze utilization reports to monitor and improve service efficiency.
• Support staff hiring, training, and professional development initiatives.
• Ensure regulatory compliance across all utilization management activities.
• Coordinate with clinical teams, providers, and internal partners to enhance care outcomes and service quality.

Role: Utilization Management Team Lead

Responsibilities

• Oversee clinical reviews to assess medical necessity and appropriateness of care.
• Manage discharge planning processes to ensure effective patient transitions.
• Analyze utilization reports to monitor and improve service efficiency.
• Support staff hiring, training, and professional development initiatives.
• Ensure regulatory compliance across all utilization management activities.
• Coordinate with clinical teams, providers, and internal partners to enhance care outcomes and service quality.

Qualifications & Skills

• Strong leadership and team management abilities.
• Experience in clinical review processes and utilization management.
• Excellent analytical skills to interpret utilization data.
• Knowledge of healthcare regulations and compliance standards.
• Effective communication and collaboration skills to coordinate with diverse healthcare professionals.