Manager, Utilization Management
Core
Manages Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams to ensure appropriate care to members.
Role type
Manager, Utilization Management
Builds
Healthcare utilization management operations and compliance
Domain
Healthcare / Managed Care
Required skills
Healthcare leadership, Utilization management, Managed care, Clinical review, Appeals management, Policy development, Team coaching, Data analysis, Regulatory compliance, Change management
Preferred skills
Supervisory experience, Knowledge of utilization management principles
Technologies
Microsoft Office
Responsibilities
Manage prior authorization, concurrent review, appeals, and retrospective clinical review teams; Review and analyze utilization management activities, operations, costs, and forecasted data; Develop and maintain compliance with utilization management policies and procedures; Review utilization management reports to identify trends and provide recommendations to senior leadership; Educate the utilization management team on key initiatives; Work with senior management to develop UM policies and guidelines; Provide coaching and guidance to ensure adherence to quality and performance standards; Assist senior leadership with onboarding, hiring, and training team members; Lead and champion change within scope of responsibility.
Seniority
Manager, hands-on leadership