Ops Leader, Utilization Management

Medica; St. Louis (MO); On-site; USD 70,000 - 105,000; Full time

Job summary

Medica is seeking a Supervisor, Utilization Management - Ops to lead a team responsible for triage, review coordination, and provider-related submissions. This role drives cross-functional process improvements and ensures regulatory compliance while maintaining service levels.

Office-based with collaboration across Health Management and other segments. The candidate should have 3+ years in healthcare leadership, strong communication, and change-management skills, with a focus on operational

Qualifications

• Bachelor's degree or equivalent combination of education and work experience
• 3+ years of direct leadership experience, either through managerial experience or through leadership roles that require coaching, mentorship and performance evaluation
• 3+ years healthcare experience

Responsibilities

• Ensures workflow is efficient and effective; requests completed within department standards and regulatory guidelines
• Identifies and assists in resolution of escalated and/or complex issues
• Communicates and implements department/team changes and decisions
• Oversees timecard approval and PTO reviews
• Facilitates start-to-end hiring process; interviews, paperwork and onboarding schedule
• Maintains accessibility and availability to facilitate problem solving and resolution of case reviews and complex issues
• Develops and oversees monitoring and updating of department SOPs and communicates changes
• Prioritizes high-volume requests and communicates plan to the team
• Identifies and initiates process improvements
• Supports daily operations and long-range planning for department
• Collaborates with department and all business segments for consistent communication

Skills

Leadership

Healthcare knowledge

Communication

Stakeholder management

Problem solving

Education

Bachelor's degree or equivalent

Job description

Medica is seeking a Supervisor, Utilization Management - Ops to lead a team responsible for triage, review coordination, and provider-related submissions. This role drives cross-functional process improvements and ensures regulatory compliance while maintaining service levels.

Office-based with collaboration across Health Management and other segments. The candidate should have 3+ years in healthcare leadership, strong communication, and change-management skills, with a focus on operational