Job description
Job Purpose The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients. The Project Manager, Utilization Review will oversee implementation coordination, stakeholder management, utilization data analysis
Duties & 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
Qualifications
Active RN license required
Utilization Review experience (required)
4+ years Healthcare compliance and utilization review experience required
3+ 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
Working Conditions
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
Physical Demands: 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
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
Work Environment: The noise level in the work environment is usually minimal
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
Originally posted on Himalayas
Who can apply
The source lists worldwide eligibility. Accepted UTC offsets: UTC-11, UTC-10, UTC-9.5, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC-4, UTC-3.5, UTC-3, UTC-2, UTC-1, UTC+0, UTC+1, UTC+2, UTC+3, UTC+3.5, UTC+4, UTC+4.5, UTC+5, UTC+5.5, UTC+5.75, UTC+6, UTC+6.5, UTC+7, UTC+8, UTC+8.75, UTC+9, UTC+9.5, UTC+10, UTC+10.5, UTC+11, UTC+12, UTC+12.75, UTC+13, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.