Manager, Specialty Care Management

This is a fully remote position, open to applicants in Utah.

📋 Description

• Lead the Restriction Team, commonly known as Medicaid Lock-in.

• Supervise, guide, and mentor Registered Nurses (RNs) or Behavioral Health Care Managers, Utilization Review clinicians, and support staff.

• Manage daily operations, staffing, resource allocation, and optimize workflows.

• Oversee departmental budgets and conduct performance evaluations.

• Develop, implement, and monitor programs, processes, and outcome standards for Utilization Review and Care Management.

• Promote interdisciplinary collaboration among members, families, providers, and payers.

• Ensure adherence to NCQA, CMS, Joint Commission standards, and patient safety initiatives.

• Advocate for continuous improvement, identify gaps, and monitor internal processes and metrics.

• Coordinate safe transitions of care, discharge planning, and repatriation to participating providers.

• Create and present reports on program performance, outcome measures, and return on investment.

• Support staff development, mentorship, and community outreach initiatives.

⛳️ Requirements

• Bachelor’s degree in Nursing (BSN) from an accredited institution or a Master’s Degree in Clinical Social Work (LCSW).

• Current licensure with compact privileges; must transfer licenses within 60 days.

• Experience in leadership or supervisory roles within clinical or managed care environments.

• A minimum of two years of clinical experience and one year in care management or utilization review.

• Excellent written and verbal communication skills.

• Intermediate computer skills with the ability to troubleshoot independently.

• Completion of required leadership training within one year of accepting the position.

• Preferred: Master’s degree in a clinical, education, or business field.

• Preferred: Specialty certification in care management or utilization review.

• Preferred: Experience in program development and oversight.

• Preferred: Strong project management and organizational abilities.

• Capability to read and assess information, documents, and monitors.

• Frequent verbal communication and auditory skills for effective interactions with colleagues and providers.

• Manual dexterity for using computers and handling equipment.

• May be required to sit or stand for prolonged periods.

• For positions involving driving: ability to drive and interpret signs, signals, and other vehicles.

🏝️ Benefits

• Comprehensive benefits package supporting programs for a healthy, happy, secure, connected, and engaged lifestyle.

• Remote work expectations include utilization of company equipment.

• Commitment to equal opportunity employment.