Head of Utilization & Complex Care Management

AbsoluteCARE Medical Center & Pharmacy; Columbus (OH); Hybrid; USD 90,000 - 125,000; Full time

Job summary

AbsoluteCARE Medical Center & Pharmacy is seeking an experienced Manager to lead the Utilization Management, Transitional Care, and Care Management teams. The role partners with Medical Center leadership to improve health outcomes, reduce utilization costs, and facilitate effective transitions across inpatient, ambulatory, and community settings.

The Manager will oversee staff performance evaluations, training, and adherence to NCQA standards, while working with leadership to uphold high service

Qualifications

• Minimum License: Current, active, and unrestricted license in a health or human services discipline that allows independent assessment (RN/LCSW/LMSW).
• BLS/CPR required.

Responsibilities

• Lead and manage a diverse care management team including RNs and social workers.
• Oversee staff development, performance management and adherence to care management standards.
• Ensure care plans, assessments and member engagement audits are completed.
• Conduct performance management activities and coaching to ensure quality and compliance.
• Manage caseloads to ensure timely documentation and regulatory compliance.
• Facilitate interdisciplinary care team meetings and coordinate with medical leadership.
• Monitor KPIs and drive performance improvements in utilization and outcomes.
• Coordinate transitions of care and collaboration with community providers.

Job description

AbsoluteCARE Medical Center & Pharmacy is seeking an experienced Manager to lead the Utilization Management, Transitional Care, and Care Management teams. The role partners with Medical Center leadership to improve health outcomes, reduce utilization costs, and facilitate effective transitions across inpatient, ambulatory, and community settings.

The Manager will oversee staff performance evaluations, training, and adherence to NCQA standards, while working with leadership to uphold high service