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...