Manager of Denials & Utilization Review

JOB ID: EB-4971828700

Are you well versed in denials and utilization? An expert in healthcare revenue with excellent managerial and interpersonal skills? If so, our client would love an opportunity to talk with you about their Manager of Denials & Utilization Review opening. The successful candidate will have experience in the management of denials and appeals between system and outside payers. Be responsible for concurrent utilization review and management of patients within the system. Serve as a liaison and point of contact for all denial and appeal inquiries. Focus areas include denials and appeals, compilation of management reports such as: 1) denials in progress, 2) wins/partial wins/losses, 3) cases where system has elected not to appeal based on chart documentation/support, and 4) identified cases pending review. Concurrent with these activities, the manager will identify and report on the categorization of denials, suspected or emerging trends related to payer denials and/or slow payment, and lead action planning for correction and process changes to eliminate avoidable denials.


  • Bachelor’s degree in Business, Accounting, Finance, Nursing or related field from an accredited college or university
    Current nursing license in good standing.
  • If not an active California nursing license, would need to become certified in California upon hire. Certification in case management preferred.
  • Must be able to demonstrate an understanding of InterQual and Milliman guidelines, community standards relevant to inpatient acute care, and payer denial and appeal processes.
  • Must be able to exercise independent discretion and judgment, and act at all times with the highest degree of professionalism and objectivity.
  • Must be computer literate and able to manage Outlook, Word and Excel programs, prepare charts and graphs, and analyze data to identify trends and opportunities for process improvement.
  • Knowledge of various spreadsheet applications, including Microsoft Word. Knowledge of billing requirements related to charges.
  • 2+ direct patient care experience as an RN in an acute care setting.
  • 3+ years of experience working with denials and appeals, utilization review, and case management in an acute care setting.
  • 2+ years supervisory experience.


Please send your resume in Word or PDF format to: [email protected]
Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Manager of Denials & Utilization Review (EB-4971828700)

If you have any questions or would like additional information please call (888) 646-1330


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Posted By: nearterm-admin
Managed RCM