Remote Utilization Management Leader

Yamhill Community Care; McMinnville (OR); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Yamhill Community Care in Oregon seeks an experienced Utilization Management leader to oversee the UM team and related activities, ensuring alignment with regulatory and contractual standards. The role collaborates with the Nursing Director and CMO to apply medical necessity policies and drive program improvement.

The position requires supervising UM staff, ensuring timely, compliant reviews, and coordinating across departments to optimize care quality for Medicaid members in the YCCO network.

Qualifications

• Bachelor’s degree in Nursing or healthcare field (required)
• Three or more years of experience supervising or leading teams
• Two or more years of Utilization Management experience
• Master’s degree in Nursing or healthcare-related field (preferred)
• Experience with Coordinated Care Organization (CCO) / Medicaid managed care (preferred)

Responsibilities

• Oversee the Utilization Management program and direct supervision of UM staff.
• Ensure UM activities meet Oregon Administrative Rules (OARs) and contractual obligations.
• Collaborate with CMO and Nursing Director–RN to apply medical necessity policies.
• Lead process improvement within the UM program and coordinate with multiple departments.
• Ensure regulatory standards and performance metrics are met and reported.

Skills

Regulatory compliance

UM leadership

Data analysis

Healthcare administration

Education

Bachelor’s degree in Nursing or healthcare field

Master’s degree (preferred)

Job description

Yamhill Community Care in Oregon seeks an experienced Utilization Management leader to oversee the UM team and related activities, ensuring alignment with regulatory and contractual standards. The role collaborates with the Nursing Director and CMO to apply medical necessity policies and drive program improvement.

The position requires supervising UM staff, ensuring timely, compliant reviews, and coordinating across departments to optimize care quality for Medicaid members in the YCCO network.