Trinity Health · 18 hours ago
Utilization Management Team Lead
Des Moines, IA
Full-time
Onsite
Senior Level
5+ years expTrinity Health is a healthcare organization seeking a Utilization Management Team Lead to oversee the UM department's daily activities. This role involves leadership, collaboration with multidisciplinary teams, and ensuring effective management of utilization processes to improve patient outcomes.
DeliveryHealth Care
Responsibilities
Overseeing day-to-day activities within the Utilization Management (UM) department, including staffing, assignment management, and serving as the first line of escalation for problem-solving
Ensures effective leadership and delegation of daily UM activities and workflows
Intervening with payers to prevent denial escalation, managing in-house expedited appeals, and conducting medical reviews for post-claim audits
Providing education on payer requirements, regulations, and standard work practices to the UM staff
Collaborating with the Director of Care Coordination/Case Management and a multidisciplinary team
Facilitating daily activities of the UM department and provides leadership to the team
Assisting the Director in hiring, training, coaching, and evaluating personnel
Maintaining confidentiality regarding personnel matters within the department
Working with healthcare providers to assess medical necessity and appropriateness of inpatient admissions, providing feedback on documentation to support these decisions
Collaborating with the team to maximize financial reimbursement for MercyOne Central Hospital through accurate and timely clinical documentation
Coordinating with the Pre-service Team to ensure pre-certification for patients with complex diagnoses or care settings, in accordance with payer requirements
Maintaining strong relationships with insurance payers to facilitate authorization approvals
Collaborating with the Revenue Cycle, HIM, Denials, and Finance teams
Recognized as an expert in UM practices and technical skills
Demonstrating effective communication (verbal, written, and digital) in various forms including medical records, emails, and phone calls
Consulting with other professionals to improve patient outcomes
Utilizing current literature to guide practices and improve outcomes
Seeking assistance in conflict resolution when needed
Effectively delegating tasks to other UM team members and evaluating their performance
Completing assigned learning materials and competency activities within orientation and beyond
Contributing to the professional growth of others by serving as a preceptor, coach, and mentor
Assisting in managing resources to meet quality and financial goals
Performing other duties as assigned by the manager
Maintaining knowledge of relevant federal, state, and local regulations, as well as Trinity Health’s Organizational Integrity Program, Standards of Conduct, and other policies to ensure adherence
Qualification
Required
Comprehensive knowledge of Utilization Management, typically gained through a bachelor's degree in Nursing, Healthcare Administration, or a related field, or equivalent relevant UM work experience
A minimum of 5 years of Utilization Management experience
Current Registered Nurse License in the State of Iowa required
Comfortable working in a collaborative, shared leadership environment
Strong personal presence characterized by honesty, integrity, and a caring attitude, with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health
Preferred
Previous leadership experience preferred
Certification in Utilization Management preferred
Company
Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation.
10001+ employees
H1B Sponsorship
Trinity Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (9)
2024 (12)
2023 (10)
2022 (9)
2021 (7)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$0.02MKey Investors
Centers for Disease Control and Prevention
2025-10-17Grant· $0.02M
Leadership Team
Dan Drake
Trinity Health PACE President and CEO
Eileen Coogan
Pres/CEO Allegany Franciscan Ministries
Recent News
2026-01-16
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