Remote Utilization Management Leader

Yamhill Community Care Organization; United States; Hybrid; USD 110,000 - 140,000; Full time

Job summary

Yamhill Community Care is seeking a Utilization Management Manager to lead the UM team, ensuring compliant reviews, policies, and timely reporting. You will collaborate with the Nursing Director, CMO, and associates across departments to optimize care quality and regulatory adherence.

The role requires overseeing day-to-day UM operations, staff supervision, and data-driven process improvements to support the triple aim for YCCO members. Remote/hybrid work options apply within authorized states.

Qualifications

• Bachelor’s degree in Nursing or healthcare field and active licensure (per the stated requirements).
• 3+ years of experience supervising or leading teams.
• 2+ years of Utilization Management experience.
• Master’s degree and professional certifications (ACM, CCM, RN-BC, CPHQ) preferred.

Responsibilities

• Oversee and manage the UM program deliverables.
• Supervise UM staff and ensure compliance with OARs and regulations.
• Collaborate with the CMO and Nursing Director to implement policies.
• Drive performance improvement within UM and prepare reports.
• Coordinate with Care Management for member transitions.

Skills

Regulatory knowledge

UM regulations

Leadership

Data analysis

Communication skills

Remote work

Education

Bachelor’s degree in Nursing or healthcare-related field

Master’s degree in Nursing or healthcare-related field

Tools

Microsoft Office Suite

Job description

Yamhill Community Care is seeking a Utilization Management Manager to lead the UM team, ensuring compliant reviews, policies, and timely reporting. You will collaborate with the Nursing Director, CMO, and associates across departments to optimize care quality and regulatory adherence.

The role requires overseeing day-to-day UM operations, staff supervision, and data-driven process improvements to support the triple aim for YCCO members. Remote/hybrid work options apply within authorized states.