Medical Utilization Review Senior Manager

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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. Being a Medical Utilization Review Senior 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 Senior Manager requires a bachelor's degree. Typically reports to a director. The Medical Utilization Review Senior Manager 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. To be a Medical Utilization Review Senior Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments.