Hybrid Utilization Management Leader

Cambia Health Solutions; Boise (ID); Hybrid; USD 112,000 - 152,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off and holidays

401(k) with company match

Parental leave up to 12 weeks

Wellness programs

Job summary

Cambia Health Solutions is seeking a Manager Utilization Management to lead teams across multiple offices in a hybrid role. You will oversee staff, budgets, and program quality, ensuring efficient utilization and payment review processes while aligning with organizational goals and regulatory standards.

The role emphasizes leadership, clinical expertise, and collaboration with government officials, providers and partners to improve member health journeys.

Qualifications

• Bachelor’s degree in nursing or related field; masters preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.
• Current unrestricted RN licensure in the United States.

Responsibilities

• Lead development and execution of utilization and payment review policies.
• Manage staff performance reviews, development and retention.
• Communicate organizational objectives and monitor metrics.
• Manage department budget and resources; oversee project plans.
• Establish long-term goals and adapt operational plans as needed.
• Provide education and resources about programs to stakeholders.
• Maintain clinical competency with current practices.

Skills

Leadership

Communication

Collaboration

Budgeting

Staff coaching

Process improvement

AI tools usage

Education

Bachelor's degree in nursing or related field

Master's degree preferred

Tools

AI tools

Job description

Cambia Health Solutions is seeking a Manager Utilization Management to lead teams across multiple offices in a hybrid role. You will oversee staff, budgets, and program quality, ensuring efficient utilization and payment review processes while aligning with organizational goals and regulatory standards.

The role emphasizes leadership, clinical expertise, and collaboration with government officials, providers and partners to improve member health journeys.