Supervisor Utilization Management

Cambia Health Solutions; Yakima (WA); Remote; USD 86,000 - 141,000; Full time

Job summary

Cambia Health Solutions is seeking a Supervisor Utilization Management to oversee a dedicated team in enhancing patient care and efficiency in health services. This role involves leadership, oversight of utilization management activities, and ensuring compliance with healthcare regulations while providing exceptional support to team members. The position offers flexible work options across several states, reflecting Cambia's commitment to innovation and care in health management.

Benefits

Medical, dental, and vision coverage

Generous paid time off

401(k) with company match

Paid parental leave

Wellness programs

Qualifications

• 3 years of leadership experience and 5 years of clinical experience required.
• Must have a current unrestricted Registered Nurse (RN) license.
• Must possess a license in a health-related field.

Responsibilities

• Supervises team activities to achieve business objectives.
• Monitors results ensuring compliance with medical policy and necessity guidelines.
• Assists in development of productivity and quality standards.

Skills

Leadership

Clinical Utilization Management

Communication

Problem Solving

Education

Bachelor’s degree in Nursing or related field

Registered Nurse (RN) license

Job description

Supervisor Utilization Management

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the Utilization Management Inpatient leadership team, our Supervisor Utilization Management supervises the team and acts as a resource for utilization management professional and support staff.Oversees and coordinates team activities to achieve business objectives and ensure medically necessary, cost-effective, quality care is delivered to members through various utilization management programs, including prior authorization and inpatient concurrent review, and regulatory compliance. May also be responsible for ensuring that medical payments are appropriate and in alignment with contract provisions, proper coding and policy compliance – all in service of making our members’ health journeys easier.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Are you passionate about improving healthcare journeys? Do you find yourself naturally guiding your colleagues and thinking about how processes could work better for our members? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor’s degree in Nursing or related field

• 3 years of leadership experience and 5 years of clinical experience or equivalent combination of education and experience

• Must have license or certification, in a state or territory of the United States in the health or human services-related field that allows the professional to conduct an assessment as permitted within the scope of practice of the discipline (e.g. medical vs. behavioral health) and at least three years full time equivalent direct clinical care.

• Must have a current unrestricted Registered Nurse (RN) license in a state or territory of the United States

Skills and Attributes:

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.

• Ability to communicate effectively, verbally and in writing including with members, employer or provider groups.

• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).

• Demonstrated experience in recognizing problems and effectively resolving complex issues.

• Familiarity with health insurance industry trends and technology.

• Demonstrated competency related to clinical utilization management and care management practices.

• Ability to apply best practices and designated standards.

• Knowledge of payment coding guidelines, as applicable (Payment Review only).

What You Will Do at Cambia:

• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.

• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and medical necessity guidelines.

• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed.

• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers. Collaborates with physician advisors on complex case and coverage determination processes.

• Participates in the hiring process, provides on-going coaching, employee development and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.

• Completes special projects as assigned and may provide back-up support to staff as needed.

• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.

• May develop and present educational updates to other departments.

• May develop and present educational updates internally or to other departments.

• Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued and implements improvements as appropriate.

The expected hiring range for a Supervisor Utilization Management is $91,800 - $124,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $86,000 - $141,000.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail] . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .