Manager, UM Preservice Review

Avalon Administrative Services LLC•Tampa, FL

3h•Hybrid

About The Position

The Manager, UM Preservice Review oversees the daily operations of preservice utilization management activities, leading a team of nurse clinicians. This role is responsible for workload management, staff development, and maintaining standard operating procedures (SOPs). In partnership with Team Lead, the manager ensures effective inventory oversight, prioritization, and adherence to service level agreements (SLAs). The role collaborates with executive leadership, vendors, and Medical Directors to ensure consistent application of clinical criteria and accurate medical necessity determinations. This position is accountable for clinical quality, accuracy, turnaround times (TAT), and compliance with contractual SLAs. This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Requirements

5 years experience performing preservice review
1-2 years direct or indirect people leadership
Bachelor’s degree or 10 years equivalent experience
Active Unrestricted Multi-State Nursing License – LPN Required/RN Preferred
Demonstrated ability to interpret documents
Excellent communication skills both verbal and written
Ability to navigate and master proprietary software programs and proficient in MS Office; specifically, Outlook, PowerPoint, Word, and Excel
Healthcare / payor knowledge and experience, including CMS regulatory understanding

Nice To Haves

MBA preferred

Responsibilities

Ensure accurate and timely review of all preservice requests for medical necessity using current health plan policies and criteria
Manage day-to-day operations of preservice UM functions, including workload distribution, staff development, and SOP maintenance
Serve as escalation point for complex or high-priority issues requiring additional research or handling
Oversee timekeeping and payroll reporting for direct reports (via ADP)
Conduct regular 1:1 meetings focused on productivity, quality, and professional development
Lead performance management processes, including mid-year and annual evaluations, goal setting, and corrective action plans as needed
Manage onboarding and training for new hires; ensure training materials and SOPs remain current
Collaborate with Medical Directors and external reviewers to ensure appropriate application of clinical criteria
Support delegation audits and inter-rater reliability (IRR) activities
Represent Avalon in client facing clinical or process engagements as required or requested by leadership
Perform additional duties as assigned