Senior Manager, Utilization Management (Hybrid)

Cambia Health Solutions; Fargo (ND); Hybrid; USD 101,000 - 137,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401(k) with company match

Paid time off

Job summary

Cambia Health Solutions seeks a Manager of Utilization Management for a hybrid role, requiring leadership in clinical care and a strong background in insurance processes. This role guides staff across multiple offices in a collaborative environment and supports ongoing program improvements to ensure quality outcomes.

Ideal candidates hold an RN license, a nursing-related degree, and several years of leadership and insurance experience, with a preference for a master's degree.

Qualifications

• Bachelor's degree in nursing or related field; masters preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.
• Current unrestricted RN licensure in US

Responsibilities

• Leads development and execution of utilization management policies and standards.
• Oversees policy updates and process improvements for quality and service excellence.
• Manages staff performance reviews, coaching, and retention.
• Develops supervisors and participates in talent management activities.
• Monitors departmental goals and regulatory compliance.
• Allocates budget and resources and oversees project plans.

Skills

Leadership experience

Clinical care

Communication skills

Team building

Health insurance knowledge

Education

Bachelor's degree in nursing or related field

Master's degree preferred

RN licensure

Job description

Cambia Health Solutions seeks a Manager of Utilization Management for a hybrid role, requiring leadership in clinical care and a strong background in insurance processes. This role guides staff across multiple offices in a collaborative environment and supports ongoing program improvements to ensure quality outcomes.

Ideal candidates hold an RN license, a nursing-related degree, and several years of leadership and insurance experience, with a preference for a master's degree.