Manager, Utilization Management

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

📋 Description

• Oversee teams involved in Prior Authorization, Concurrent Review, Retrospective Review Clinical Review, and/or Appeals.

• Ensure that members receive appropriate care while adhering to relevant guidelines, policies, and procedures.

• Analyze and assess utilization management activities, operations, costs, and projected data to pinpoint areas for improvement.

• Develop, implement, and sustain policies and procedures related to utilization management.

• Examine utilization management reports, detect trends, and offer recommendations to senior leadership.

• Keep abreast of utilization management processes, regulations, accreditation standards, and industry best practices.

• Educate and supply resources to the utilization management team.

• Foster communication among the utilization management team, members, and providers.

• Work in collaboration with senior management to create and apply UM policies, procedures, and guidelines.

• Provide updates and insights regarding team goals and objectives.

• Mentor and guide the utilization management team to meet quality and performance standards.

• Assist with the onboarding, hiring, and training of team members.

• Lead and advocate for change within the defined scope of responsibility.

• Perform additional duties as assigned and ensure compliance with policies and standards.

⛳️ Requirements

• Candidates must be residents of Oklahoma.

• An active RN license is required: either State Licensure or Compact State Licensure.

• Must be a graduate of an accredited nursing school or hold a Bachelor's degree along with 5+ years of relevant experience.

• A minimum of 2 years of supervisory experience is preferred.

• Familiarity with utilization management principles is preferred.

• Experience in healthcare leadership, utilization management, and managed care is essential.

• Must be willing to participate in weekend on-call coverage.

• Proficiency in computers and Microsoft Office applications is required.

• Strong communication and customer service skills are essential.

• Must possess a keen attention to detail, strong organizational and management skills, along with effective time management capabilities.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in the total compensation package.

• Commitment to equal opportunity and diversity.