Project Manager, Utilization Review

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Deliver operational and analytical support to Physician Advisory end-to-end clients.

• Prepare for and participate in client review meetings, which includes creating decks, data summaries, and presentations.

• Monitor deliverables, timelines, and handle client escalations.

• Assist in the client onboarding process and manage operational handoffs.

• Analyze utilization data, case trends, and performance metrics for clients.

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

• Generate data-driven summaries and recommendations for leadership consideration.

• Take part in the evaluation of hospital utilization review processes and the application of screening tools.

• Support the reporting infrastructure and validate data in PowerBI.

• Lead special projects for end-to-end clients as needed.

• Provide assistance with time-sensitive deliverables and client requests.

• Oversee project timelines, resources, and coordination among stakeholders.

• Act as the operational point of contact for end-to-end clients.

• Aid in resolution of escalations and track issues.

• Contribute to enhancements in operational efficiency.

• Use, protect, and disclose patients’ protected health information solely in compliance with HIPAA standards.

• Adhere to Information Security and HIPAA policies and procedures.

• Restrict access to protected health information to the minimum necessary.

⛳️ Requirements

• Active RN license is mandatory.

• Experience in Utilization Review is essential.

• A minimum of 4 years in healthcare compliance and utilization review experience is required.

• At least 3 years of project management experience is necessary.

• Project Management certification is advantageous.

• Proficiency in data analysis tools is required.

• Expertise in MCG and IQ applications is needed.

• Experience in end-to-end client or managed care operations is expected.

• PowerBI or data visualization experience is preferred.

• Proficiency with the Microsoft Office Suite is essential.

• Strong interpersonal and communication skills are required.

• Excellent problem-solving and creative thinking abilities are necessary.

• Ability to exercise sound judgment and make decisions based on accurate and timely analyses is crucial.

• High integrity and dependability are essential qualities.

• A strong sense of urgency and results orientation is required.

• Excellent written and verbal communication skills are mandatory.

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

• Ability to follow instructions, collaborate with others, and manage stress effectively is essential.

• Capability to perform the outlined physical and computer-related duties is required.

🏝️ Benefits

• Competitive salary and compensation package.

• Opportunities for professional development and growth.

• Comprehensive health benefits and wellness programs.

• Flexible work arrangements and work-life balance initiatives.