Project Manager, Utilization Review

Job Purpose

The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients. The Project Manager, Utilization Review will oversee implementation coordination, stakeholder management, utilization data analysis

Duties & Responsibilities

• Prepare and participate in client review meetings (decks, data summaries, presentations)

• Track deliverables, timelines, and client escalations

• Support client onboarding processes and operational handoffs

• Analyze utilization data, case trends, and client performance metrics

• Investigate clinical and operational issues for end-to-end clients

• Prepare data-driven summaries and recommendations for leadership review

• Participate in evaluation of hospital UR processes and application of screening tools (MCG, IQ)

• Support reporting infrastructure and PowerBI data validation

• Lead ad-hoc projects for end-to-end clients as directed

• Provide support on time-sensitive deliverables and client requests

• Manage project timelines, resources, and stakeholder coordination

• Serve as operational point of contact for end-to-end clients

• Support escalation resolution and issue tracking

• Contribute to operational efficiency improvements

• Other duties as assigned

• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Understand and comply with Information Security and HIPAA policies and procedures at all times

• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Active RN license required

• Utilization Review experience (required)

• 4+ years Healthcare compliance and utilization review experience required

• 3+ Project management experience required; PM certification a plus

• Proficiency with data analysis tools and MCG and IQ application expertise required

• End-to-end client or managed care operations experience

• PowerBI or data visualization experience preferred

• Proficiency in Microsoft Office Suite

• Strong interpersonal skills, ability to communicate well at all levels of the organization

• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

• High level of integrity and dependability with a strong sense of urgency and results oriented

• Excellent written and verbal communication skills required

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear

• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress

• Work Environment: The noise level in the work environment is usually minimal

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.