Utilization Review Nurse Team Lead — In-Person

PHP Staging Mobile Taleo; Dayton (OH); On-site; USD 85,000 - 110,000; Full time

Job summary

Premier Health in Dayton, OH is seeking an experienced Utilization Review Nurse Team Lead to guide UR staff, oversee medical necessity decisions, and ensure regulatory compliance. The role emphasizes collaboration with physicians, case management, and revenue cycle teams to optimize patient throughput and minimize denials.

The position requires a BSN or higher, an active Ohio RN license, and 3–5 years in UR, with leadership experience and knowledge of InterQual/ Milliman guidelines preferred.

Qualifications

• Bachelor’s degree required.
• Valid RN license in the State of Ohio required.
• 3–5 years of job-related experience required.
• Previous experience as a Utilization Review Nurse required.
• Certification in a clinical specialty such as case management, utilization review, critical care, or rehab preferred.
• Knowledge of InterQual ISD-A and Milliman Guidelines preferred.
• Knowledge of third‑party insurance requirements preferred.
• Proficiency in Microsoft Office required.

Responsibilities

• Lead UR team to ensure appropriate patient status and medical necessity.
• Collaborate with physicians, case management, CDI, coding, and revenue cycle teams.
• Provide mentorship and staff development for UR nurses.
• Assist with staffing, scheduling, and workload distribution.
• Monitor adherence to CMS regulations and payer requirements.
• Participate in denial reviews and appeals as needed.
• Track KPIs like review timeliness and denial rates.

Skills

Leadership

Mentoring

Regulatory knowledge

Education

Bachelor’s degree

RN license in Ohio

Tools

Microsoft Office

Job description

Premier Health in Dayton, OH is seeking an experienced Utilization Review Nurse Team Lead to guide UR staff, oversee medical necessity decisions, and ensure regulatory compliance. The role emphasizes collaboration with physicians, case management, and revenue cycle teams to optimize patient throughput and minimize denials.

The position requires a BSN or higher, an active Ohio RN license, and 3–5 years in UR, with leadership experience and knowledge of InterQual/ Milliman guidelines preferred.