Utilization Review Manager

The Utilization Review Manager oversees and directs all operations of the Utilization Review department, ensuring the effective use and monitoring of healthcare resources to support positive clinical, financial, and operational outcomes. The role involves reviewing medical record documentation for compliance with regulatory and payer requirements, verifying medical necessity criteria for patient admissions, and collaborating with social services on discharge planning. The manager also evaluates managed care denials, provides clinical reviews to maintain compliance, and leads departmental initiatives for operational efficiency and quality improvement.