Utilization Review Manager (Healthcare)

Location: Remote nationwide within the United States; travel to and work onsite at client, temporary, or corporate office locations may be required as business needs require. Applicants must reside in and be authorized to work within the United States.

Salary: $92,400–$138,600 per year, based on experience.

Company

hirify.global provides technology-enabled revenue cycle management and related healthcare solutions for hospitals, health systems, and affiliated physician groups.

What you will do

• Lead and manage the centralized Virtual Utilization Management Program covering inpatient, observation, and outpatient authorizations, denials, and appeals.
• Develop annual utilization management work plans and report progress to revenue cycle and care management leadership.
• Oversee virtual utilization management staffing, productivity, effectiveness, and operational performance.
• Collaborate with care coordination, clinical documentation, health information management, coding, physicians, and revenue department leaders.
• Drive process redesign to reduce excess days, length of stay, inpatient and observation denials, and failed billing outcomes.
• Manage departmental budgets, compliance activities, studies, committees, and continuous improvement initiatives.

Requirements

• Associate degree in Nursing required; a Bachelor's degree in Nursing is preferred.
• Current unrestricted nursing license in the resident state.
• MCG certification required within six months of hire.
• Broad knowledge of MCG or nursing criteria guidelines and insurance, Medicare, and Medicaid regulations.
• Experience with database and spreadsheet analysis, staffing productivity, budget management, and interdisciplinary collaboration.
• Must reside in and be authorized to work within the United States.

Nice to have

• Advanced use of AI and experience managing teams that apply AI to process and technology improvements.

Culture & Benefits

• Remote work with business-related travel and onsite assignments when required.
• Comprehensive healthcare, time off, retirement, and well-being benefits.
• Paid professional certifications and tuition reimbursement.
• Bonus incentives, recognition programs, and opportunities for career advancement.
• Culture focused on collaboration, growth, innovation, customer obsession, and work-life flexibility.