Minnesota Licensed Utilization Review Manager

Job Summary

Seeking a full-time Minnesota Licensed Utilization Review Manager, this remote position will manage the design and implementation of utilization review functions, oversee daily operations, and supervise staff to achieve clinical and financial goals.

Key responsibilities:

• Direct and manage a team of Utilization Review Coordinators, promoting employee satisfaction and supporting staff development
• Collaborate with various departments to ensure accurate medical necessity screening and compliance with regulatory requirements
• Develop processes to manage and respond to third-party payer denials and improve denial prevention strategies

Required qualifications:

• Bachelor's degree in nursing or related field
• Three to five years of leadership experience
• Five years of clinical experience
• A minimum of one year of utilization review experience
• Current Registered Nurse licensure from the Minnesota Board of Nursing upon hire