Medical Utilization Review Manager

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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. Being a Medical Utilization Review Manager 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. Additionally, Medical Utilization Review Manager requires a bachelor's degree. Typically reports to a director. The Medical Utilization Review Manager 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. To be a Medical Utilization Review Manager 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.