Project Manager, Utilization Review

About the Role

The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients, overseeing implementation coordination, stakeholder management, and utilization data analysis.

Responsibilities

• Prepare and participate in client review meetings (decks, data summaries, presentations)
• Track deliverables, timelines, and client escalations
• Support client onboarding processes and operational handoffs
• Analyze utilization data, case trends, and client performance metrics
• Investigate clinical and operational issues for end-to-end clients
• Prepare data-driven summaries and recommendations for leadership review
• Participate in evaluation of hospital UR processes and application of screening tools (MCG, IQ)
• Support reporting infrastructure and PowerBI data validation
• Lead ad-hoc projects for end-to-end clients as directed
• Provide support on time-sensitive deliverables and client requests
• Manage project timelines, resources, and stakeholder coordination
• Serve as operational point of contact for end-to-end clients
• Support escalation resolution and issue tracking
• Contribute to operational efficiency improvements
• Other duties as assigned
• Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Requirements

• Active RN license required
• Utilization Review experience (required)
• 4+ years Healthcare compliance and utilization review experience required
• 3+ years Project management experience required; PM certification a plus
• Proficiency with data analysis tools and MCG and IQ application expertise required
• End-to-end client or managed care operations experience
• PowerBI or data visualization experience preferred
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem-solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results-oriented
• Excellent written and verbal communication skills required
• Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes

Working Conditions

• While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals, and telephones; extend arms; kneel; talk and hear.
• The employee must be able to follow directions, collaborate with others, and handle stress.
• The noise level in the work environment is usually minimal.