Manager, Utilization Management

Job Summary

The Manager of Utilization Management is responsible for overseeing day-to-day operations across multiple client UM projects. This role combines project management with hands-on leadership of clinical teams, ensuring compliance, performance, and client satisfaction. The manager serves as a resource and SME to internal teams and acts as the key point of contact for client leadership.

Essential Functions/Key Responsibilities:

• Lead and manage assigned UM projects, including oversight of W2 and 1099 nurse teams.
• Serve as the UM subject matter expert and escalation point for clinical guidance.
• Act as the primary liaison to client leadership, providing updates and demonstrating value.
• Ensure productivity, audit compliance, turnaround times, and quality standards are met.
• Conduct regular audits and coach team members to maintain clinical excellence.
• Support staffing alignment and placement strategies with internal leadership.
• Monitor team engagement and proactively manage to reduce turnover.
• Deliver performance reporting and insights to internal and external stakeholders.
• Support onboarding and training of new team members.
• Partner with SVP to identify areas for process improvement and operational efficiency.

Competencies:

• Leads by example, motivates others, and manages team dynamics effectively.
• Thrives in fast paced, evolving environments and adjusts quickly to changing client needs.
• Applies sound clinical reasoning to support decision making and guidance.
• Builds trust with clients, anticipates their needs, and delivers high value outcomes.
• Sets clear expectations, measures performance, and takes ownership of outcomes.
• Works cross functionally with internal teams and client stakeholders to achieve aligned goals.
• Anticipates challenges, investigates root causes and develops solutions.
• Provides regular feedback and mentors team.
• Champions operational efficiency.

Required education and experience:

• Minimum 5 years of Utilization Management experience.
• At least 2 years of leadership or team management in a UM setting.
• Active, unrestricted RN license required
• Strong understanding of InterQual and/or MCG criteria.
• Experience managing remote clinical teams across multiple engagements
• Familiarity with Medicare, Medicaid, and commercial payer UM requirements.
• Excellent communication, data analysis, and problem-solving skills.

Preferred education, certifications and/or experience:

• Consulting or project-based experience preferred.

Physical Requirements/Work environment:

• Remote role with occasional travel (Less than 5%)
• Must have a home office, mobile phone, computer with security requirements met.
• Prolonged periods of sitting at a desk and working on a computer.
• Ability to speak, hear, and comprehend both written and verbal communications.

Other duties:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without advanced notice.

Pay: $100,000.00 - $130,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• Utilization Management: 5 years (Required)
• leadership (UM setting): 2 years (Required)

License/Certification:

• RN License (Required)

Work Location: Remote