Manager – Utilization Management

Manager – Utilization Management

Requirements

• Bachelor’s degree in a healthcare or other related field, OR equivalent combination of education and experience required
• 5 years experience in utilization management operations in a health care industry required
• Prior experience in a leadership role managing teams required

Responsibilities

• Provide clinical leadership within utilization management activities guiding design, evolution, and implementation of the operations related to the clinical review processes and service levels
• Provide leadership and guidance to the team to include Workforce Management
• Provide leadership and guidance to the team to include Quality Management
• Provide leadership and guidance to the team to include Performance Management
• Provide oversight of the team’s higher complexity cases
• Develop and maintain the workflows, policies and procedures that govern and guide staff activities
• Collaborate with interdepartmental and interdisciplinary teams to achieve improved member outcomes
• Manage conflicts and escalations, high profile cases, and ensures proper notification of high dollar cases
• Assist senior leadership in the screening and hiring process for team members
• Ensure professional communication and collaboration within the team
• Identify for design, and ensure execution of key team processes that foster interdepartmental and interdisciplinary collaboration for improved member outcomes
• Provide input to senior leadership to maintain vendor relationships, process improvement, and system integration
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• All other duties as assigned

Preferred Qualifications

• Strongly prefer within a healthcare payer organization
• Strongly prefer health care payer, operations, and change management expertise