Lead Utilization Review - RN

Responsibilities:

• Set daily direction for your UM team: Establish priorities, reinforce expectations, and build a culture where clinical quality and accountability are the norm.
• Coach reviewers on criteria application: Guide consistent use of medical-necessity criteria, medical policy, and benefit language.
• Monitor workflow health daily: Track intake volume, aging cases, and turnaround risk.

Qualifications:

• Active RN license.
• Experience in utilization management, clinical review, or case management.
• Background applying medical-necessity criteria and benefit plan interpretation in a healthcare payer or clinical review setting.

Benefits:

• Competitive base salary and benefits effective day one.
• Comprehensive medical and dental through our own health solutions.
• Paid Time Off, mental health support, retirement planning, and financial protection.

Our Commitment:

• Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging.
• We cultivate a work environment where differences are celebrated.
• All official communication comes from verified company email addresses.