Description
The Utilization Management (UM) Program Manager plays a vital role in driving the strategic planning, execution, and continuous enhancement of UM programs. The position ensures the delivery of clinically appropriate and cost-effective care by optimizing utilization management processes across the organization.Key Responsibilities: - Lead and manage UM programs to align with organizational goals for quality, efficiency, and compliance.
- Collaborate closely with clinical UM, Care Management, Quality, Information Technology (IT), and other key stakeholders, to streamline authorization workflows and improve operational efficiency
- Develop and implement strategies to reduce avoidable denials and enhance patient throughput
- Ensure adherence to regulatory and accreditation standards through Effective program oversight and compliance monitoring
- Coordinate complex, multi work stream initiatives that involve cross functional teams
- Utilize data analytics to inform decision making, identify opportunities for improvement, and measure program outcomes
- Standardize UM processes, tools, and documentation to promote consistency and scalability
- Facilitate communication and change management efforts to support successful program adoption and sustainability
- Support other clinical departments as needed to advance organizational objectives
Salary Range: $70,900-$145,200/annually QualificationsRequired: - Bachelor’s degree in healthcare administration, business, public health, or a related field and/or equivalent experience
- 5+ years of related experience or training in healthcare operations, utilization management, care management, quality, revenue cycle, contracting, or related operational/program work
- 3+ years of experience leading cross functional projects or programs that include workflow improvement, stakeholder coordination, and measurable outcomes (may be included within the 5+ years)
- Strong analytical skills to define metrics, interpret trends, and translate findings into action plans
- Ability to communicate clearly in writing and verbally with clinicians, administrators, and technical partners
- Facilitate work groups and meetings effectively including agendas, decision capture, and follow up tracking
- Uses sound judgment to prioritize work, manage competing deadlines and raise risks early
- Ability to build collaborative relationships across departments and supports constructive resolution of workflow issues
- Designs scalable workflows, documentation, and controls that support consistent operations and sustainment
- Maintains discretion and protects sensitive information learned through work activities
Preferred
- Master’s degree (MPH, MHA, MSN, MBA) or equivalent advanced training
- Demonstrates working knowledge of UM workflows such as prior authorization, concurrent review, and denials/appeal.
- Uses UM tools and reporting methods (e.g. InterQual/MCG, authorization platforms, self-service reporting) to support outcomes
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