Remote Utilization Management Leader

Yamhill Community Care Organization; McMinnville (OR); Hybrid; USD 110,000 - 160,000; Full time

Benefits offered by this job

Annual Company Conference in Oregon

Job summary

Yamhill Community Care Organization is seeking a UM Manager to oversee the Utilization Management team, ensuring regulatory compliance and effective operations. You will collaborate with the Nursing Director-RN and CMO to implement policies and drive quality outcomes.

The role requires leadership in a fast-paced regulatory environment, supervision of UM staff, and cross-department collaboration to support member care and optimal transitions between levels of care.

Qualifications

• Requires supervision or team leadership experience.
• Two (2+) years of Oregon Medicaid or equivalent UM leadership experience.
• Three (3+) years of supervisory or team leadership experience.

Responsibilities

• Oversee and manage the Utilization Management (UM) program and staff.
• Coordinate across departments to meet regulatory and contractual obligations.
• Develop and implement process improvements within UM.
• Provide consultation on UM to physicians and staff across the organization.

Skills

Leadership

Regulatory compliance

Data analysis

Communication

Education

Bachelor’s degree in Nursing or Healthcare

Master’s degree preferred

Tools

McKesson InterQual

Medicare/Medicaid guidelines

HERC Guidelines

QIO/RAC knowledge

Denial Management knowledge

Job description

Yamhill Community Care Organization is seeking a UM Manager to oversee the Utilization Management team, ensuring regulatory compliance and effective operations. You will collaborate with the Nursing Director-RN and CMO to implement policies and drive quality outcomes.

The role requires leadership in a fast-paced regulatory environment, supervision of UM staff, and cross-department collaboration to support member care and optimal transitions between levels of care.