Hiring: Lead Utilization Review - RN Company: Personify Health Location: United States Job Posted Time: 2026-09-16 23:36:26 Employment Type: Remote Target Skills & Keywords : CPT, HIPAA, ICD-10, REST About the job Experience: •Background applying medical-necessity criteria and benefit plan interpretation in a healthcare payer or clinical review setting Required Skills: •Ready to lead the clinical team that keeps care moving when it matters most? •Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time, with rotating Saturday coverage as required. •Set daily direction for your UM team: Establish priorities, reinforce expectations, and build a culture where clinical quality and accountability are the norm, not the exception. •Coach reviewers on criteria application: Guide consistent use of medical-necessity criteria, medical policy, and benefit language, and step in with real-time answers when interpretations vary. •Monitor workflow health daily: Track intake volume, aging cases, and turnaround risk; flag barriers to the UM Manager with a recommendation attached, not just a problem. •Audit for documentation quality: Review reviewer work for completeness and audit readiness, then coach for sharper clinical rationale and tighter regulatory timeliness. •Build reviewer capability: Run shadowing plans, job aids, and competency check-ins for new and existing staff; identify training gaps and propose solutions before they become bigger problems. •Resolve cross-team barriers: Partner with providers, facilities, Case Management, Appeals, and Provider Relations to clear roadblocks and keep determinations moving. Compensation: •Comprehensive medical and dental through our own health solutions (yes, we use what we build) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!