Project Manager, Utilization Review

Med Metrix•Parsippany-Troy Hills, NJ

About The Position

The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients. The Project Manager, Utilization Review will oversee implementation coordination, stakeholder management, and utilization data analysis.

Requirements

Active RN license required
Utilization Review experience (required)
4+ years Healthcare compliance and utilization review experience required
3+ Project management experience required
Proficiency with data analysis tools and MCG and IQ application expertise required
End-to-end client or managed care operations experience
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required

Nice To Haves

PM certification a plus
PowerBI or data visualization experience preferred

Responsibilities

Prepare and participate in client review meetings (decks, data summaries, presentations)
Track deliverables, timelines, and client escalations
Support client onboarding processes and operational handoffs
Analyze utilization data, case trends, and client performance metrics
Investigate clinical and operational issues for end-to-end clients
Prepare data-driven summaries and recommendations for leadership review
Participate in evaluation of hospital UR processes and application of screening tools (MCG, IQ)
Support reporting infrastructure and PowerBI data validation
Lead ad-hoc projects for end-to-end clients as directed
Provide support on time-sensitive deliverables and client requests
Manage project timelines, resources, and stakeholder coordination
Serve as operational point of contact for end-to-end clients
Support escalation resolution and issue tracking
Contribute to operational efficiency improvements
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties