Project Manager – Utilization Management & Data Analysis

About the role

We are seeking a Project Manager to lead Utilization Management (UM) initiatives, focusing on data analysis, workflow optimization, and system enhancements within a healthcare setting. The role bridges clinical teams, IT, and leadership to drive cost‑containment and regulatory compliance.

Key responsibilities

• Analyze utilization trends, claims, and pharmacy data to uncover cost‑containment opportunities.
• Document, review, and improve UM processes such as intake, concurrent review, and appeals.
• Define business requirements for IT solutions and lead user acceptance testing for UM software.
• Ensure all UM activities comply with state, federal, and accreditation standards.
• Act as a liaison between clinical staff (nurses, medical directors) and IT/leadership teams.

Required profile

• 3‑5+ years of experience in Utilization Management, care management, or managed care.
• Bachelor’s degree in Healthcare Administration, Nursing, or a related field.
• RN or LPN license is highly preferred for clinical data interpretation.
• Strong knowledge of healthcare coding (ICD‑10, CPT), claims processing, and insurance regulations.

Required skills

• SQL and relational database querying.
• Data visualization tools such as Tableau and Power BI.
• Advanced Excel and SAS for data analysis.
• Workflow modeling with Visio.
• Familiarity with electronic health record (EHR/EMR) systems.