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Utilization Review Manager
Personify HealthManager overseeing Utilization Management operations for Personify Health. Leading staff performance and ensuring quality standards in care management practices.
About the role
Key responsibilities & impact- Supervise day-to-day operations of assigned Utilization Management staff, including scheduling, workload distribution, and adherence to established workflows.
- Provide full people management for assigned Utilization Management teams, including hiring, performance management, and staff development.
- Provide routine coaching, feedback, auditing, support and disciplinary action to ensure productivity, quality, and timeliness standards are met.
- Monitor documentation for completeness, accuracy, timeliness and compliance with company policies and regulatory requirements.
- Analyze operational and quality data to identify trends, gaps, and opportunities for improvement.
- Drive team performance against key metrics, including engagement, productivity, quality scores, and turnaround times.
- Collaborate with cross-functional partners to resolve issues and improve care coordination.
- Prepare team for internal and external audits (e.g., NCQA, URAC) and support responses to findings.
Requirements
What you’ll need- Current, unrestricted RN license in the United States or U.S. territory (compact license acceptable where applicable)
- Graduate of an accredited nursing program (ADN or diploma required; BSN preferred)
- Knowledgeable of the Federal, State, DMHC, CMS and ERISA regulations
- 1-2 years in care management, utilization management, discharge planning, or related clinical coordination
- Minimum 1 year of compliance related experience preferred.
- Certification in Case Management or Utilization Review preferred but not required.
- 1+ year of informal leadership (preceptor/mentor/lead) or some direct people leadership
- Working understanding of HIPAA, member rights, scope of practice, and documentation requirements
- Strong written communication (member notes, provider communications)
- Basic data literacy: productivity, caseload management, simple reports/dashboards
- Conflict de-escalation and customer service mindset (members/providers)
Benefits
Comp & perks- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Unlimited PTO—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
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
utilization managementcare managementdischarge planningcompliancedata analysisperformance managementauditingdocumentationcase managementclinical coordination
Soft Skills
people managementcoachingfeedbackconflict de-escalationcustomer servicecommunicationteam performancecollaborationleadershiporganizational skills
Certifications
RN licenseCase Management certificationUtilization Review certification