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Manager, UM Preservice Review
Avalon Healthcare SolutionsManager overseeing preservice utilization management at Avalon Healthcare Solutions. Leading a team of clinicians to ensure accurate and timely reviews for medical necessity.
About the role
Key responsibilities & impact- Oversee daily operations of preservice utilization management activities
- Lead a team of nurse clinicians
- Responsible for workload management, staff development, and maintaining standard operating procedures (SOPs)
- Ensure effective inventory oversight, prioritization, and adherence to service level agreements (SLAs)
- Collaborate with executive leadership, vendors, and Medical Directors for clinical criteria and medical necessity determinations
- Accountable for clinical quality, accuracy, turnaround times (TAT), and compliance with contractual SLAs
Requirements
What you’ll need- 5 years experience performing preservice review
- 1-2 years direct or indirect people leadership
- Bachelor’s degree or 10 years equivalent experience
- Active Unrestricted Multi-State Nursing License – LPN Required/RN Preferred
- Demonstrated ability to interpret documents
- Excellent communication skills both verbal and written
- Ability to navigate and master proprietary software programs and proficient in MS Office; specifically, Outlook, PowerPoint, Word, and Excel
- Healthcare / payor knowledge and experience, including CMS regulatory understanding
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
preservice reviewworkload managementstaff developmentclinical qualityaccuracyturnaround timescomplianceinventory oversightmedical necessity determinationsstandard operating procedures
Soft Skills
leadershipcommunicationcollaborationorganizational skillsproblem-solvinginterpersonal skillsattention to detailadaptabilitydecision-makingtime management
Certifications
Active Unrestricted Multi-State Nursing LicenseLPNRN