Manager, Utilization Management

Manager, Utilization Management

The Manager, Utilization Management oversees and develops staff to ensure individual and team performance and quality of work aligns to organizational objectives and the strategic direction of the department. This role will collaborate with department and multi-disciplinary clinical teams to facilitate positive member outcomes. The role will support implementation of strategies to achieve and maintain optimal wellness and will identify and support resolution of operational and technical challenges in the department. Five years experience in utilization management operations in a health care industry required; strongly prefer within a healthcare payer organization.

Essential Job Duties & 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

Essential Skills & Abilities

Core Competencies / Demonstrable Behaviors

Education and / or Experience

Supervisory Responsibilities

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to :