Revenue Cycle Managed Services - Utilization Management (UM) / Utilization Review (UR) Lead

Advisors, LLC is a nationally recognized healthcare management consulting firm delivering Best in KLAS advisory, implementation, and optimization services.

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Responsibilities

• To learn more about us, visit www.impact-advisors.com Position Summary The Utilization Review (UR) / Utilization Management (UM) Lead is responsible for day-to-day leadership of the utilization management program for an assigned healthcare client.
• The role oversees concurrent review, continued-stay review, admission and level-of-care status, retrospective review, and related appeals, and ensures reviews are timely, criteria-based, and aligned with payer and regulatory requirements.
• Working with client clinical, case management, revenue cycle, and physician leadership, the UM Lead improves review productivity and turnaround times, reduces authorization and medical-necessity denials, and supports length-of-stay and throughput goals.
• The role combines operational management, performance monitoring, and practical process improvement.
• This position requires regular (25%) travel to the Chicago area.
• Operational Leadership Lead operational assessments of utilization management, case management, patient throughput, and care coordination functions.
• Evaluate current-state workflows, organizational structures, staffing models, and performance metrics.
• Design and implement scalable operational improvements that increase efficiency and improve service delivery.
• Implement operational improvements that increase review efficiency, consistency, and service delivery.
• Partner with client operational leaders and teams to prioritize UM initiatives that improve performance.
• Utilization Management Operations Direct daily UM operations, including work distribution, review prioritization, escalation, and coverage.
• Promote consistent application of medical-necessity criteria and appropriate level-of-care status.
• Manage physician-advisor referral and secondary-review processes for cases that do not meet criteria.
• Oversee optimization of prior authorization, concurrent review, retrospective review, and appeals workflows.
• Analyze utilization patterns and operational performance to identify opportunities for improvement.
• Improve turnaround times, productivity, and service-level agreement performance.
• Support implementation of utilization management technologies, automation tools, and workflow enhancements.
• Establish operational standards and key performance indicators for ongoing monitoring and accountability.
• Revenue Cycle & Denials Prevention Collaborate with revenue cycle, patient access, and clinical operations leaders to reduce authorization-related denials.
• Improve alignment between utilization management, clinical documentation, case management, and revenue cycle functions.
• Develop operational strategies that support reimbursement optimization and financial performance.
• Analyze denial trends and implement corrective action plans to reduce preventable revenue leakage.
• Support initiatives focused on medical necessity documentation and payer compliance.
• Throughput & Capacity Management Partner with case management and patient-flow leaders on length of stay, discharge barriers, and avoidable days tied to utilization decisions.
• UM-related barriers to care progression and status determination.
• Establish dashboards and reporting tools to monitor throughput performance and operational outcomes.
• Improvement & Transformation Lead targeted operational improvement initiatives within the client UM program.
• Utilize Lean, Six Sigma, or other performance improvement methodologies to redesign workflows.
• Facilitate stakeholder engagement sessions, process mapping workshops, and change management activities.
• Implement performance management frameworks focused on measurable outcomes and continuous improvement.
• Management Analyze operational, financial, and utilization data to identify trends and improvement opportunities.
• Develop executive-level dashboards, scorecards, and performance reports.
• Monitor productivity, turnaround times, denial rates, length of stay, and resource utilization metrics.
• Present findings and recommendations to client operational leaders.
• Translate complex data into actionable operational strategies.
• Provide functional leadership to UM team.
• Coach staff on criteria use, documentation, escalation, and productivity expectations.
• Contribute to playbooks, training, and standard work for the UM program.
• Support business development efforts, including proposal development and client presentations.

Requirements

• Qualifications Bachelor's degree in Healthcare Administration, Nursing, Business Administration, Public Health, or a related field.
• 7+ years of experience in healthcare operations, utilization management, care management, revenue cycle, or performance improvement.
• 3+ years of leadership experience managing operational teams, transformation initiatives, or consulting engagements.
• Strong understanding of utilization management operations, patient throughput, care coordination, and healthcare reimbursement.
• Experience leading operational improvement initiatives within provider, payer, or consulting environments.
• Strong analytical, project management, and stakeholder engagement skills; able to manage competing priorities.

Preferred

• Qualifications Master's degree in Healthcare Administration (MHA), Business Administration (MBA), Public Health (MPH), Nursing, or a related field.
• Consulting experience supporting hospitals, health systems, physician groups, or health plans.
• Experience with denials management, revenue cycle optimization, and patient flow improvement initiatives.
• Familiarity with InterQual®, MCG, Epic, Cerner, or other utilization management and care management platforms.
• Registered Nurse (RN) license preferred but not required.

Pay

• For salaried positions, this role may also be eligible for an annual performance bonus.
• Additional benefits and perks may also be available, depending on the position and employment terms.
• This range reflects consideration of several factors, including skills, experience, training, certifications, and organizational needs.