Utilization & Complex Care Management Leader

AbsoluteCare; Philadelphia (Philadelphia County); On-site; USD 110,000 - 170,000; Full time

Job summary

AbsoluteCare seeks a Manager of Utilization Management and Complex Care Management to lead UM, transitional care and CCM teams across inpatient, ambulatory, and community settings in the Philadelphia area. You will drive process improvements, ensure compliance with NCQA standards, and partner with leadership to optimize transitions and outcomes.

The role requires 7–10 years in care management with 3–5 years in leadership, CCM credentials, and strong data/communication skills.

Qualifications

• Current, active license in a health or human services discipline.
• CCM credentials or obtain within 24 months of hire.
• BLS/CPR required.
• Bachelor’s degree in health or human services.
• Master’s degree in Healthcare Administration/Public Health or related field a plus.
• Other certifications considered: CMAC, CHE, CPHQ or similar.

Responsibilities

• Lead and manage a diverse care management team across settings.
• Oversee staff development and ensure adherence to standards.
• Conduct performance management including coaching and training.
• Manage caseloads for timely follow-up and compliance.
• Coordinate with providers and payors for transitions of care.
• Drive improvements using data and reporting.
• Promote member engagement and evidence-based practices.

Skills

Leadership

Data analysis

EHR proficiency

Communication

Performance improvement

Education

Bachelor’s degree in health or human services

Master’s degree in Healthcare Administration/Public Health or related field

Tools

EHR systems

Microsoft Office

Job description

AbsoluteCare seeks a Manager of Utilization Management and Complex Care Management to lead UM, transitional care and CCM teams across inpatient, ambulatory, and community settings in the Philadelphia area. You will drive process improvements, ensure compliance with NCQA standards, and partner with leadership to optimize transitions and outcomes.

The role requires 7–10 years in care management with 3–5 years in leadership, CCM credentials, and strong data/communication skills.