Utilization Review Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Utilization Review Manager based in United States. This is a strategic clinical leadership role overseeing a centralized Virtual Utilization Management program in a complex healthcare environment.

You will lead teams responsible for utilization review, authorizations, denials, and appeals across inpatient, observation, and outpatient services. The role combines clinical expertise with operational leadership, regulatory compliance, financial accountability, and continuous process improvement. You will collaborate with hospital-based leaders, physicians, care coordination, clinical documentation, coding, and revenue cycle teams to improve outcomes and reduce unnecessary costs.

A key focus will be optimizing length of stay, strengthening denial and appeal performance, and maintaining high standards of program compliance. This remote opportunity is ideal for an experienced nursing and utilization management leader who is comfortable driving change, developing teams, and leveraging technology and AI to improve healthcare operations.