| Medical Utilization Review Senior Manager Job Description |
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| The following is a full job description for Medical Utilization Review Senior Manager. Here are the requirements and responsibilities for Medical Utilization Review Senior Manager along with statistics. If after reading this page you determine that Medical Utilization Review Senior Manager is not the position you are looking for, you may want to try one of these similar titles: Medical Utilization Review Manager, Medical Utilization Review Director, Medical Utilization Review Supervisor, Medical Utilization Review Specialist I, Medical Utilization Review Specialist III, Medical Utilization Review Specialist II, Medical Affairs Senior Manager, Dental Utilization Review Analyst, Medical Claims Review Manager |
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| Requirements and Responsibilities For Medical Utilization Review Senior Manager |
| Oversees and 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. Typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. |
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| Also referred to as: Healthcare Utilization Review Senior Manager |
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| Similar Jobs: Medical Utilization Review Manager, Medical Utilization Review Director, Medical Utilization Review Supervisor, Medical Utilization Review Specialist I, Medical Utilization Review Specialist III, Medical Utilization Review Specialist II, Medical Affairs Senior Manager, Dental Utilization Review Analyst, Medical Claims Review Manager |
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| Level of Education: Medical Utilization Review Senior Manager Salaries with No Diploma, Medical Utilization Review Senior Manager Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Senior Manager Salaries with an Associate's Degree, Medical Utilization Review Senior Manager Salaries with a Bachelor's Degree, Medical Utilization Review Senior Manager Salaries with a Master's Degree or MBA, Medical Utilization Review Senior Manager Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
