Utilization Management Manager
New
I
IntusCareHealthcare
This is a fully remote role based in the United States.Full-TimeManager
Salary115,000 USD per year
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Job Details
- Experience
- 7+ years of utilization management experience; 5+ years of direct people-management experience
- Required Skills
- Quality AssuranceTeam managementData analytics
Requirements
- Current, active Registered Nurse (RN) license in good standing.
- 7+ years of utilization management experience in risk-based, integrated care models.
- 5+ years of direct people-management experience leading clinical reviewers or UM nurses.
- Demonstrated experience owning and improving inter-rater reliability and QA programs.
- Strong proficiency with clinical decision support criteria such as MCG or InterQual.
- Data literacy with experience using dashboards and analytics to drive interventions.
- Proven ability to manage competing priorities in a fast-paced environment.
- Excellent written and verbal communication skills for presenting to executive and client audiences.
- Experience implementing or scaling UM operations across multiple client organizations (preferred).
- Certification in case management or utilization review (e.g., CCM, ACM, CPHM) (preferred).
- Experience with rapid-cycle improvement methodologies like PDSA, Lean, or Six Sigma (preferred).
Responsibilities
- Manage UM team performance to meet or exceed SLAs for turnaround times, decision timeliness, and quality benchmarks.
- Conduct one-on-ones, performance reviews, and coaching sessions to drive team accountability and professional development.
- Design and execute quality assurance and inter-rater reliability activities to ensure consistent application of PACE policies.
- Oversee staffing, workload distribution, and recruitment for the clinical team.
- Handle complex UM cases, concurrent reviews, and escalated provider disputes personally for 25% of the time.
- Utilize data analytics to monitor care patterns, cost drivers, and utilization efficiency to lead performance improvement initiatives.
- Partner with internal leadership and external PACE client stakeholders to ensure alignment on care strategies and reporting.
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