Remote Lead, Utilization Operations & Analytics

Sacbar; Pearland (TX); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Remote work flexibility

Remote work option

Job summary

Kelsey-Seybold Clinic is seeking a Senior Manager to lead non-clinical Utilization Management support services, including authorization intake, workflow management, and operational reporting. The role partners with clinical and IT leadership to improve efficiency, compliance, and audit readiness.

Location in Pearland, TX with remote work flexibility. The role emphasizes supervising teams, driving performance, and implementing automation to reduce turnaround times while ensuring regulatory

Qualifications

• Bachelor's degree required.
• 5+ years of supervisory or management experience in healthcare operations.
• Managed Care experience.
• Experience supervising administrative healthcare teams.
• Experience in workforce management.
• Experience in operational reporting.
• Experience in process improvement.
• Experience in Microsoft Office Suite.
• Strong written and verbal communication.
• Strong organizational and analytical skills.
• Strong interpersonal and leadership skills.
• Demonstrated ability to manage multiple priorities simultaneously.

Responsibilities

• Oversee daily administrative Utilization Management operations.
• Supervise Utilization Operations Supervisors and Utilization Management Representatives.
• Oversee authorization intake, provider inquiries, work queues, correspondence, administrative support, and workflow management.
• Review operational reporting, universes, productivity metrics, work queue aging, staffing trends, and dashboards to identify opportunities for improvement.
• Implement workflow redesign, automation, and operational improvements to increase efficiency and reduce manual effort.
• Develop staff through coaching, performance management, and leadership development.
• Serve as primary operational escalation point for administrative issues.
• Ensure compliance with CMS, delegated health plan requirements, internal policies, and procedures.
• Review universes, delegation evidence, audit documentation, and reporting accuracy.
• Identify operational trends and develop corrective action plans.

Skills

Supervisory experience

Managed Care

Healthcare operations

Workforce management

Operational reporting

Process improvement

Microsoft Office

Communication skills

Organizational skills

Leadership skills

Multitasking

Education

Bachelor's Degree

Master's degree

Tools

Epic

Power BI

Job description

Kelsey-Seybold Clinic is seeking a Senior Manager to lead non-clinical Utilization Management support services, including authorization intake, workflow management, and operational reporting. The role partners with clinical and IT leadership to improve efficiency, compliance, and audit readiness.

Location in Pearland, TX with remote work flexibility. The role emphasizes supervising teams, driving performance, and implementing automation to reduce turnaround times while ensuring regulatory