| Medical Utilization Review Manager Job Description |
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| The following is a full job description for Medical Utilization Review Manager. Here are the requirements and responsibilities for Medical Utilization Review Manager along with statistics. If after reading this page you determine that Medical Utilization Review Manager is not the position you are looking for, you may want to try one of these similar titles: Medical Utilization Review Senior Manager, Medical Utilization Review Supervisor, Medical Utilization Review Director, Medical Utilization Review Specialist I, Medical Utilization Review Specialist II, Medical Utilization Review Specialist III, Dental Utilization Review Analyst, Medical Claims Review Manager, Utilization Review Technician |
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| Requirements and Responsibilities For Medical Utilization Review Manager |
| Manages the team responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Requires a bachelor's degree. Typically reports to a director. Manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. |
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| Also referred to as: Healthcare Utilization Review Manager |
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| Similar Jobs: Medical Utilization Review Senior Manager, Medical Utilization Review Supervisor, Medical Utilization Review Director, Medical Utilization Review Specialist I, Medical Utilization Review Specialist II, Medical Utilization Review Specialist III, Dental Utilization Review Analyst, Medical Claims Review Manager, Utilization Review Technician |
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| Level of Education: Medical Utilization Review Manager Salaries with No Diploma, Medical Utilization Review Manager Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Manager Salaries with an Associate's Degree, Medical Utilization Review Manager Salaries with a Bachelor's Degree, Medical Utilization Review Manager Salaries with a Master's Degree or MBA, Medical Utilization Review Manager Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
