Manager, UM Preservice Review
Not Disclosed•Full-TimeHybrid
location_on3164, Saint Conrad Street West, Macfarlane Park, West Tampa, Tampa, Hillsborough County, Florida, 33607, United States
About Avalon Healthcare Solutions
Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.
Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.
With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value.
Learn more at www.avalonhcs.com.
Work location
Work model: Hybrid
3164, Saint Conrad Street West, Macfarlane Park, West Tampa, Tampa, Hillsborough County, Florida, 33607, United States
Tampa, Florida
Key Responsibilities
- check_circleEnsure accurate and timely review of preservice requests for medical necessity using current health plan policies
- check_circleManage day-to-day operations of preservice utilization management functions including workload distribution and SOP maintenance
Similar Job Opportunities
Skills, education and keywords
Skills: Utilization Management, Preservice Review, Medical Necessity Determinations, Clinical Criteria, Standard Operating Procedures, Service Level Agreements, Turnaround Times, Adherence Audits, Inter-Rater Reliability, CMS Regulatory Understanding.
Education: Bachelor's degree or 10 years equivalent experience; MBA preferred.
Frequently asked questions about Manager, UM Preservice Review at Avalon Executive Assistants LLC
What does a Manager, UM Preservice Review at Avalon Executive Assistants LLC do?expand_more
In this Manager, UM Preservice Review at Avalon Executive Assistants LLC role, you will ensure accurate and timely review of preservice requests for medical necessity using current health plan policies; manage day-to-day operations of preservice utilization management functions including workload distribution and sop maintenance; serve as escalation point for complex or high-priority issues requiring additional research or handling; and oversee timekeeping and payroll reporting for direct reports via adp.
What are the requirements for this Manager, UM Preservice Review role?expand_more
To qualify for the Manager, UM Preservice Review at Avalon Executive Assistants LLC position, applicants should have: 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); Healthcare/payor knowledge and experience including CMS regulatory understanding; and Proficient in MS Office (Outlook, PowerPoint, Word, Excel).