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Manager, UM Preservice Review

Avalon Administrative Services LLC

Tampa, FL

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JOB DETAILS
SKILLS
ADP, Business Administration, Clinical Outcomes, Communication Skills, Content Management Systems (CMS), Corrective Action, Customer Relations, Ecosystems, Establish Priorities, Genetics, Health Plan, Healthcare, Healthcare Quality, Internal Rate of Return (IRR), Inventory Management, Leadership, Licensed Practical Nurse/Licensed Vocational Nurse, Medical Waste, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Nursing, Nursing Credentials, Onboarding, Operations, Performance Management, Performance Modeling, Presentation/Verbal Skills, Regulations, Service Level Agreement (SLA), Set Goals, Staff Development, Standard Operating Procedures (SOP), Team Lead/Manager, Test Automation, Time Management, Utilization Management, Willing to Travel, Writing Skills
LOCATION
Tampa, FL
POSTED
Today

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.

You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability. 

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Manager, UM Preservice Review Position:

The Manager, UM Preservice Review oversees the daily operations of preservice utilization management activities, leading a team of nurse clinicians. This role is responsible for workload management, staff development, and maintaining standard operating procedures (SOPs). In partnership with Team Lead, the manager ensures effective inventory oversight, prioritization, and adherence to service level agreements (SLAs). The role collaborates with executive leadership, vendors, and Medical Directors to ensure consistent application of clinical criteria and accurate medical necessity determinations. This position is accountable for clinical quality, accuracy, turnaround times (TAT), and compliance with contractual SLAs.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Manager, UM Preservice Review – Essential Functions and Responsibilities:

  • Ensure accurate and timely review of all preservice requests for medical necessity using current health plan policies and criteria 
  • Manage day-to-day operations of preservice UM functions, including workload distribution, staff development, and SOP maintenance 
  • Serve as escalation point for complex or high-priority issues requiring additional research or handling 
  • Oversee timekeeping and payroll reporting for direct reports (via ADP) 
  • Conduct regular 1:1 meetings focused on productivity, quality, and professional development 
  • Lead performance management processes, including mid-year and annual evaluations, goal setting, and corrective action plans as needed 
  • Manage onboarding and training for new hires; ensure training materials and SOPs remain current 
  • Collaborate with Medical Directors and external reviewers to ensure appropriate application of clinical criteria 
  • Support delegation audits and inter-rater reliability (IRR) activities
  • Represent Avalon in client facing clinical or process engagements as required or requested by leadership
  • Perform additional duties as assigned

Manager, UM Preservice Review – Minimum Qualifications:

  • 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
  • Demonstrated ability to interpret documents
  • Excellent communication skills both verbal and written 
  • Ability to navigate and master proprietary software programs and proficient in MS Office; specifically, Outlook, PowerPoint, Word, and Excel
  • Healthcare / payor knowledge and experience, including CMS regulatory understanding

Manager, UM Preservice Review – Preferred Qualifications:

  • MBA preferred


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About the Company

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Avalon Administrative Services LLC