MU Health Care is seeking proposals from qualified professional firms interested in providing Consulting to fill or support the role of Utilization Review (UR) Director. The consultant will be expected to perform some or all of the following: Serve as Interim Director of Utilization Review (if needed). Conduct a comprehensive review of UR workflows, tools, policies, and documentation. Assess compliance with federal, state, and payer guidelines (e.g., CMS Two-Midnight Rule, medical necessity reviews). Evaluate UR staff roles, training, and performance. Develop or refine metrics, dashboards, and reporting tools for UR effectiveness. Identify opportunities for alignment with revenue cycle and clinical operations. Provide leadership during DNV or CMS audits related to UR. This RFP may be awarded to a single or multiple suppliers as determined to be in the best interests of MUHC at the sole discretion of MUHC.
