UTILIZATION REVIEW NURSE (RN) - TEAM LEAD

Premier Health Partners; Dayton (OH); On-site; USD 85,000 - 105,000; Full time

Job summary

Premier Health – SYSTEM SUPPORT in Dayton, OH, is seeking a Utilization Review Nurse Team Lead to serve as both clinical expert and operational leader for the UR team. Lead staff development, mentor team members, and partner with physicians, case management, CDI, coding, and revenue cycle teams to drive compliant admission status decisions and prevent denials.

The Team Lead focuses on improving patient throughput, regulatory adherence, and reimbursement optimization while fostering a

Qualifications

• RN with utilization review experience.
• Willing to commute and work in-person in the Dayton, OH area.
• Preferred candidates live within 60 miles driving distance to Dayton, OH.

Responsibilities

• Serve as the primary review resource for UR nurses.
• Mentor and develop UR staff.
• Assist manager with staffing, scheduling, and workload distribution.
• Facilitate team huddles and staff meetings.
• Provide guidance on admission status determinations.
• Assist with complex medical reviews using CMS and payer-specific criteria.
• Support escalation of cases to the physician advisor team.
• Monitor compliance with CMS regulations and payer requirements.
• Identify trends leading to medical necessity and level of care denials.
• Collaborate with physician advisors and revenue cycle teams to reduce denials.
• Participate in denial reviews and appeal preparation.
• Participate in regular audits of UR staff for accuracy of status assignment and performance.

Job description

Full-Time / Day Shift / 7:00 am - 4:30 pm
If you’re an experienced utilization review nurse looking for the next step in your career, this is an opportunity to lead meaningful work that directly impacts patient care, regulatory excellence, and organizational performance. In this role, you’ll have the chance to combine your clinical expertise with leadership responsibilities, helping guide a team, support sound admission status decisions, prevent avoidable denials, and improve patient throughput. For professionals motivated by influence, collaboration, and the ability to make a measurable difference, this position offers both purpose and professional growth.

PREMIER HEALTH – SYSTEM SUPPORT
110 N MAIN ST, DAYTON, 45402
DEPT: CENTER FOR STATUS INTEGRITY
Full-Time / Day Shift / 7:00 am - 4:30 pm
Premier Health offers the opportunity to work in a highly collaborative environment where your voice and experience matter. As the Utilization Review Nurse - Team Lead, you will serve as both a clinical expert and an operational leader, supporting staff development, mentoring team members, and partnering closely with physicians, case management, CDI, coding, and revenue cycle teams. This role is ideal for a nurse who values teamwork, process improvement, and the opportunity to shape outcomes across the continuum of care. Premier Health has built a strong reputation as a respected healthcare employer, known for its commitment to quality, patient-centered care, and professional excellence. Team members are valued for their expertise and dedication, and leaders are empowered to contribute to a culture of accountability, support, and continuous improvement. In this role, you will feel connected not only to your immediate team, but also to the broader mission of delivering the right care at the right time while maintaining compliance and optimizing reimbursement. Employees in healthcare leadership and clinical support roles often value the sense of purpose, collaboration, and trust they experience when working with a strong interdisciplinary team. In this position, you’ll be part of a professional environment where relationships matter, expertise is respected, and your leadership helps others succeed. If you enjoy mentoring peers, solving complex utilization challenges, and driving best practices in regulatory compliance and denial prevention, this role can offer a highly rewarding next step. The Utilization Review Nurse Team Lead serves as the clinical and operational leader for the UR team, ensuring appropriate patient status, medical necessity compliance, denial prevention, and regulatory adherence while supporting staff development and performance. The UR Nurse Team Lead provides day-to-day oversight of utilization review activities, including medical necessity reviews, admission status determinations, payer communications, denial management, and regulatory compliance. The Team Lead acts as a clinical resource for staff, collaborates with physicians, case management, CDI, Coding, and revenue cycle teams, and promotes efficient patient throughput while optimizing reimbursement and reducing avoidable denials.
Note: Local Candidates preferred - must be willing to commute and work "in-person" often at the Dayton, Ohio area offices
Preferred candidates will live within 60 miles driving distance to Dayton, Ohio

• Serves as the primary review resource for UR nurses
• Assists with orientation and mentoring of new staff
• Assist manager with staffing, scheduling, and workload distribution
• Assist with facilitating team huddles and with staff meetings
• Provide guidance on admission status determination
• Assist staff with complex medical reviews using CMS and payer-specific criteria
• Support escalation of cases to the physician advisor team
• Monitor compliance with the Two-Midnight rule and payer-specific requirements
• Identify trends leading to medical necessity and level of care denials
• Collaborate with physician advisors and revenue cycle teams to reduce denials
• Participate in denial reviews and appeal preparation
• Participate in regular audits of UR staff for accuracy of status assignment, clinical review integrity, and productivity
• Participate in denial data entry and collection
• Ensure compliance with CMS regulations, Medicare Conditions of Participation, commercial payer requirements, and state and accreditation standards
• Support audit readiness and regulatory reviews
• Track key performance indicators including initial review timeliness, continued stay review compliance, observation to inpatient conversion rates, and denial rates
• Lead or participate in performance improvement initiatives focused on throughput, status accuracy, and denial reduction

If you are ready to bring your utilization review expertise and leadership abilities to an organization that values collaboration, clinical excellence, and continuous improvement, consider joining Premier Health as a Utilization Review Nurse Team Lead. This is your opportunity to influence outcomes, support a high-performing team, and contribute to exceptional patient care across Ohio. to take the next step in your nursing leadership career.