Job Description
Salary Range $62,053.00 - $62,053.00 Salary
Position Type Full Time
Job Shift Any
Education Level Graduate Degree
Travel Percentage Up to 25%
Description
The Lead Utilization Review & Utilization Management Specialist (Lead UR/UMS) serves as the clinical and operational leader of the Utilization Review/Utilization Management (UR/UM) team. This senior-level position is responsible for providing direct clinical oversight, supervision, and mentorship to UR/UM Support Staff while ensuring the highest standards of clinical review, insurance advocacy, and regulatory compliance across all levels of care.
The Lead UR/UMS coordinates and manages the admissions and concurrent review process, including insurance verification, pre-authorization submission, and level-of-care determinations for all treatment levels. This position evaluates the clinical appropriateness, medical necessity, and efficiency of services, and communicates with Managed Care Orga...
Position Type Full Time
Job Shift Any
Education Level Graduate Degree
Travel Percentage Up to 25%
Description
The Lead Utilization Review & Utilization Management Specialist (Lead UR/UMS) serves as the clinical and operational leader of the Utilization Review/Utilization Management (UR/UM) team. This senior-level position is responsible for providing direct clinical oversight, supervision, and mentorship to UR/UM Support Staff while ensuring the highest standards of clinical review, insurance advocacy, and regulatory compliance across all levels of care.
The Lead UR/UMS coordinates and manages the admissions and concurrent review process, including insurance verification, pre-authorization submission, and level-of-care determinations for all treatment levels. This position evaluates the clinical appropriateness, medical necessity, and efficiency of services, and communicates with Managed Care Orga...