Hybrid Utilization Management Leader

Cambia Health; Burlington (WA); Hybrid; USD 105,000 - 172,000; Full time

Job summary

Cambia Health is seeking a Manager of Utilization Management in a hybrid role with in-office days across multiple cities including Salt Lake City, Boise, Portland, and Seattle-area offices. The role leads a team of clinicians and supports staff to optimize utilization, payment review, and program quality.

The position emphasizes leadership, policy execution, and collaboration with partners to improve member health journeys and manage budgets.

Qualifications

• Requires RN licensure in a US state or territory.
• 5 years of clinical care experience and 5 years of leadership.
• 7 years in the insurance industry or equivalent mix of education and experience.

Responsibilities

• Lead development and execution of utilization and/or payment review policies and standards.
• Oversee policy updates and process improvements to ensure quality and service excellence.
• Manage staff at management level including reviews, development, hiring, coaching and retention.
• Develop supervisors and participate in talent management activities.
• Regularly communicate organizational objectives and team goals.
• Monitor results and metrics for deliverables and compliance.
• Collaborate with leaders across departments to resolve issues.
• Manage department budget, expenditures, and resources.
• Set long-term goals and adapt plans as changes occur.
• Create visibility and support for utilization management and/or payment review programs.
• Develop educational materials and communications for employees and providers.
• Maintain clinical competency and stay current with medical practices and trends.
• May present updates to other departments.
• Oversee development and implementation of department programs.
• Ensure program quality and successful outcomes.
• Provide direction and foster a positive, growth-focused team culture.

Skills

Issue identification

Resource management

Team leadership

Communication

Industry trends

Clinical case management

Statistical analysis

AI tools

Education

Bachelor's in Nursing

Master's preferred

Job description

Cambia Health is seeking a Manager of Utilization Management in a hybrid role with in-office days across multiple cities including Salt Lake City, Boise, Portland, and Seattle-area offices. The role leads a team of clinicians and supports staff to optimize utilization, payment review, and program quality.

The position emphasizes leadership, policy execution, and collaboration with partners to improve member health journeys and manage budgets.