Hybrid Manager, Utilization Management

Cambia Health; Fargo (ND); Hybrid; USD 105,000 - 172,000; Full time

Job summary

Cambia Health in the United States seeks a Manager Utilization Management to lead the utilization management function across plans, overseeing staff, and ensuring compliance. Hybrid role with in-office 3 days/week, location-flexible from Salt Lake City to Fargo and other offices.

The role emphasizes strategic leadership, policy development, financial stewardship, and collaboration with leaders, providers, and government officials to improve member health journeys.

Qualifications

• Bachelor's degree in nursing or related field; master’s preferred.
• Minimum 5 years of clinical care experience.
• Minimum 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.

Responsibilities

• Leads the development and execution of effective utilization and/or payment review management policies, procedures and standards.
• Oversees policy updates or process improvements to ensure quality and service.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Develops supervisors and participates in talent management activities.
• Regularly communicates organizational objectives and team goals.
• Monitors results and metrics to ensure deliverables and compliance.
• Collaborates with other leaders and across departments to resolve issues.
• Manages financial targets and department budget, authorizes expenditures and monitors resources.
• Establishes long-term goals for the department and adapts plans as changes occur.
• Creates visibility and support for utilization management and/or payment programs.
• Develops resource materials and provides education on programs to staff and providers.
• Maintains clinical competency and current on medical practices and trends.
• Oversees development and implementation of department programs.
• Ensures program quality and successful outcomes.

Skills

Issue identification

Resource & project management

Team leadership

Effective communication

Health insurance industry knowledge

Clinical case management

Statistical analysis

AI tools usage

Education

Bachelor's degree in nursing

Masters degree preferred

Job description

Cambia Health in the United States seeks a Manager Utilization Management to lead the utilization management function across plans, overseeing staff, and ensuring compliance. Hybrid role with in-office 3 days/week, location-flexible from Salt Lake City to Fargo and other offices.

The role emphasizes strategic leadership, policy development, financial stewardship, and collaboration with leaders, providers, and government officials to improve member health journeys.