Director of Utilization Management & Complex Care

AbsoluteCARE Medical Center & Pharmacy; Philadelphia (Philadelphia County); On-site; USD 120,000 - 180,000; Full time

Job summary

AbsoluteCARE Medical Center & Pharmacy is seeking a Manager of Utilization Management and Complex Care Management in Philadelphia to lead UM, Transitional Care, and Care Management teams. You will drive evidence-based care transitions and collaborates with hospital and market leadership to meet KPI targets.

The role requires 7–10 years of experience, CCM credentials, and strong analytical and communication skills, with travel to community settings as needed.

Qualifications

• Minimum license in a health or human services discipline allowing independent assessment.
• CCM credentials or obtain within 24 months of hire; CMGT-BC, CCTM, C-SWCM, C-ASWCM, ACM or FAACM considered.
• BLS/CPR certification required.
• Bachelor's degree in health or human services; Master's preferred for advanced leadership roles.

Responsibilities

• Provide day-to-day operational leadership for Utilization Management and Care Management teams.
• Support processes to improve health outcomes and reduce healthcare utilization costs.
• Collaborate with Medical Center leadership and stakeholders to ensure seamless care transitions.
• Lead performance evaluations, staff development, and adherence to quality standards.
• Monitor performance metrics and implement improvements in utilization, outcomes, and patient satisfaction.
• Coordinate interdisciplinary care team meetings and follow-up actions for member outcomes.
• Oversee onboarding, hiring, and staff engagement to maintain morale and productivity.

Skills

Leadership

Care Management

Utilization Management

Data Analysis

Stakeholder Engagement

Education

Bachelor's degree in health or human services

Master's degree in Healthcare Administration/Public Health/Finance

CCM certification or equivalent

BLS/CPR certification

Tools

Microsoft Office Suite

Electronic Health Records (EHR)

Job description

AbsoluteCARE Medical Center & Pharmacy is seeking a Manager of Utilization Management and Complex Care Management in Philadelphia to lead UM, Transitional Care, and Care Management teams. You will drive evidence-based care transitions and collaborates with hospital and market leadership to meet KPI targets.

The role requires 7–10 years of experience, CCM credentials, and strong analytical and communication skills, with travel to community settings as needed.