Remote Utilization Operations Manager

Texas Health Institute; Pearland (TX); Hybrid; USD 73,000 - 130,000; Full time

Job summary

Kelsey-Seybold Clinic, part of the Optum family, seeks an experienced leader to direct non-clinical Utilization Management operations. This role partners with clinical and IT leadership to ensure compliant, efficient workflows and high-quality provider/member service.

Requirements include a Bachelor's degree and 5+ years of supervisory healthcare experience; Master’s preferred. Remote flexibility is available for Pearland, TX-based staff, with overall responsibilities spanning reporting, process

Qualifications

• Bachelor's Degree or higher required.
• 5+ years of supervisory/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 with Microsoft Office Suite.
• Strong written and verbal communication.
• Strong organizational and analytical skills.
• Proven leadership and interpersonal skills.
• Ability to manage multiple priorities.

Responsibilities

• Oversee daily non-clinical Utilization Management operations.
• Supervise Utilization Operations Supervisors and Representatives.
• Manage authorization intake, provider inquiries, work queues, correspondence, and workflow.
• Review operational reporting, universes, productivity metrics, staffing trends, dashboards.
• Lead workflow redesign and automation to increase efficiency.
• Coach staff and develop leadership capabilities.
• Serve as escalation point for administrative issues.
• Ensure CMS and health plan compliance, audit readiness.
• Monitor timelines and ensure timely reporting and deliverables.
• Support implementation of new technologies and initiatives.
• Participate in cross-functional teams and organizational projects.

Skills

Leadership

Communication

Analytical skills

Organizational skills

Team management

Education

Bachelor's Degree

Master's degree (Preferred)

Tools

Epic

Power BI

Microsoft Office Suite

Job description

Kelsey-Seybold Clinic, part of the Optum family, seeks an experienced leader to direct non-clinical Utilization Management operations. This role partners with clinical and IT leadership to ensure compliant, efficient workflows and high-quality provider/member service.

Requirements include a Bachelor's degree and 5+ years of supervisory healthcare experience; Master’s preferred. Remote flexibility is available for Pearland, TX-based staff, with overall responsibilities spanning reporting, process