Remote Care Management & Utilization Review Manager

UPMC; Northern (KY); Hybrid; USD 90,000 - 110,000; Full time

Job summary

UPMC Corporate Revenue Cycle is seeking a Clinical Manager to lead the Care Management Team. The position offers daytime hours with potential remote work and periodic on-site meetings 1-4 times annually.

The role oversees day-to-day operations of authorization, denial management, and utilization review, managing both clinical and non-clinical staff, ensuring efficient workflow and regulatory compliance, and driving staff development and quality outcomes.

Responsibilities

• Analyze data for trends and causative factors and communicate findings to leadership.
• Aggressively manage Denial and Edit resolution processes and drive improvements.
• Develop a high-performing team through training, mentoring and collaboration.
• Incorporate core values in recruitment, orientation and training of staff.
• Prioritize work assignments and adjust staffing to match volumes.
• Monitor daily staff functions and maintain productivity/quality tools.
• Ensure policies, procedures and job descriptions are up to date and comply with regulations.
• Complete HR documentation and adhere to HR expectations.
• Assist in implementing software supporting areas of responsibility.
• Serve as a resource for authorization, denial management and utilization review processes.
• Respond to organizational and customer needs with innovative programs for satisfaction.
• Communicate status with subordinates and superiors about business operations.

Skills

Data analysis

Team leadership

Utilization review

Staff development

Job description

UPMC Corporate Revenue Cycle is seeking a Clinical Manager to lead the Care Management Team. The position offers daytime hours with potential remote work and periodic on-site meetings 1-4 times annually.

The role oversees day-to-day operations of authorization, denial management, and utilization review, managing both clinical and non-clinical staff, ensuring efficient workflow and regulatory compliance, and driving staff development and quality outcomes.