Head of Utilization & Complex Care Management

AbsoluteCARE Medical Center & Pharmacy; Columbus (OH); On-site; USD 95,000 - 130,000; Full time

Job summary

AbsoluteCARE Medical Center & Pharmacy in Columbus, OH, is seeking a Manager to provide day-to-day operational leadership for Utilization Management, Transitional Care, and Care Management teams, driving interventions that improve health outcomes and reduce costs across inpatient, ambulatory, and community settings.

The role requires supervising staff, conducting performance reviews, and ensuring compliance with NCQA, regulatory, and health plan standards, while leveraging data to improve

Qualifications

• Bachelor's degree in health or human services required.
• Master's degree in H/C Admin or related field a plus.
• RN/LCSW/LISW or APP license preferred.
• Certified Care Manager is highly preferred.
• BLS/CPR certification required.
• Industry certifications (CPHQ) a plus.

Responsibilities

• Lead and manage a diverse care management team including staff.
• Ensure adherence to NCQA, regulatory and health plan standards in care planning and documentation.
• Manage caseloads to ensure follow-up and timely documentation.
• Coordinate with community-based organizations and providers to address chronic care needs.
• Facilitate interdisciplinary care team meetings with clear owners and timeframes.
• Use data and reporting to monitor performance and drive improvements.
• Serve as SME on care management and promote best practices.

Skills

Team Leadership

Performance Management

Communication

Data Analysis

Project Management

Interdisciplinary Collaboration

Education

Bachelor’s degree in health or human services

Master’s degree in Healthcare Administration/Public Health or related field

Advanced clinical practice (e.g. CNS/APN, LCSW/LISW, PsyD/PhD)

Certified Care Manager

BLS/CPR Certification

Other Certifications Considered (CPHQ)

Tools

Microsoft Office

EHR Systems

Care Management Tools

Job description

AbsoluteCARE Medical Center & Pharmacy in Columbus, OH, is seeking a Manager to provide day-to-day operational leadership for Utilization Management, Transitional Care, and Care Management teams, driving interventions that improve health outcomes and reduce costs across inpatient, ambulatory, and community settings.

The role requires supervising staff, conducting performance reviews, and ensuring compliance with NCQA, regulatory, and health plan standards, while leveraging data to improve