UR Operations Leader — Team Growth & Compliance

Utilization Review Manager Exact Billing Solutions, Lauderdale Lakes, FL (Full-Time/ On-site) About the Role The Utilization Review Manager serves as an operational people leader responsible for overseeing Team Leads and ensuring the broader Utilization Review team consistently meets productivity, quality, compliance, and departmental KPI expectations while effectively resolving escalations, supporting staff development, driving operational excellence across the department, and collaborating cross-functionally with clinical, billing, finance, quality, and leadership teams to support organizational goals and patient outcomes.

POSITION ESSENTIAL DUTIES & RESPONSIBILITIES

Provide operational leadership and oversight to Utilization Review Team Leads and the broader UR department, ensuring adherence to established workflows, productivity expectations, quality standards, documentation requirements, and organizational protocols. Monitor departmental performance through routine audits, KPI tracking, reporting, and data analysis to identify trends, operational gaps, and opportunities for process improvement, increased efficiency, and enhanced patient outcomes. Collaborate closely with the VP of Operations and cross-functional departments to implement process improvements and support the team's alignment with organizational goals. Partner with senior leadership to establish, monitor, and achieve departmental KPI goals related to productivity, quality, turnaround times, denials, and operational performance across the UR department. Serve as the leadership escalation point for complex operational, payer, patient, and authorization-related issues, and assist the team with resolution strategies, challenging negotiations, and cross-functional problem-solving. Communicate effectively with patients, families, insurance representatives, providers, and internal stakeholders to resolve escalated concerns, maintain professional relationships, and support positive patient and operational outcomes. Oversee the accuracy and integrity of data entry and documentation ensuring compliance with industry regulations. Coordinate with clinical teams to support UR Specialists and ensure timely collection of required documentation and support development of individualized treatment plans for insurance submissions and continued authorization requests. Oversee medical necessity appeals processes and partner with billing and clinical teams to proactively address denial trends through improved documentation, communication, and operational workflows. Provide ongoing coaching, mentorship, feedback, and professional development support to Team Leads and UR staff while fostering accountability, operational consistency, employee engagement, and continuous learning across the department. Lead onboarding, ongoing education, and training initiatives to ensure Team Leads and UR staff maintain strong knowledge of payer requirements, documentation standards, regulatory updates, and industry best practices. Lead and participate in departmental meetings, operational discussions, and leadership initiatives while promoting collaboration, accountability, and a team-oriented culture. Other duties as assigned. Qualifications Bachelor's degree in healthcare administration or related field (Master’s degree preferred). 4+ years of experience in utilization review or a related healthcare leadership role. 4+ years of behavioral health experience (preferred). Willingness to submit to drug and background screenings. Certifications in utilization review (e.g., URAC) are advantageous. Expertise Needed Knowledge of healthcare regulations, reimbursement practices, and utilization review principles. Strong leadership skills with the ability to inspire and motivate teams. Excellent communication and interpersonal abilities to collaborate effectively with stakeholders. Analytical mindset with the ability to use data-driven insights to inform decision-making. Benefits 21 paid days off (15 PTO days increasing with tenure, plus 6 paid holidays) Flexible Spending Account (FSA) and Health Savings Account (HSA) options Medical, dental, vision, long-term disability, life insurance, AD&D insurance, and GAP Plan (TransAmerica) Generous 401(k) with up to 6% employer match 100% employer-paid maternity/paternity leave for up to 5 weeks Tuition reimbursement up to $2,500 per semester EAP (unlimited counseling 24/7), BeyondMed (discounts on wellness and elective healthcare services), PerkSpot (discounts on top brands), Pet Insurance (Nationwide), and On the GoGawellbeing hub Closing Statement Exact Billing Solutions is an Equal Opportunity Employer and is committed to building an inclusive workplace free from discrimination. We make employment decisions based on qualifications, merit, and business needs, and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law. Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program. We are committed to providing reasonable accommodation for qualified individuals with disabilities throughout the hiring process and employment. If you require assistance or accommodation, please let us know. #J-18808-Ljbffr ICBD Holdings, LLC.