Utilization Management Lead – Health Plan (Remote/Hybrid)

Clinical Management Consultants; Eugene (OR); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Clinical Management Consultants seeks a Health Plan Utilization Management Manager for the Willamette Valley near Eugene. You will lead a team responsible for timely, well-informed care decisions, collaborating with physicians, care managers, and provider relations staff.

The role entails supervising daily UM operations, optimizing processes, and ensuring consistency with medical necessity criteria. A bachelor's in nursing or related healthcare field plus leadership experience is required;

Qualifications

• Bachelor's degree in nursing or a related healthcare field.
• At least three years of supervisory or team leadership experience.
• Two years of Utilization Management program leadership experience.
• Two years of Oregon Medicaid experience.
• Master's degree, Medicaid managed care experience, or integrated physical and behavioral health background preferred.

Responsibilities

• Oversee daily UM review operations and supervise the UM team.
• Balance workloads and monitor turnaround times.
• Coach staff on applying medical necessity criteria.
• Facilitate peer-to-peer reviews with medical leadership.
• Drive program improvements to meet Oregon Medicaid requirements.

Skills

Supervisory experience

Team leadership

Utilization management knowledge

Oregon Medicaid experience

Education

Bachelor's degree in nursing or related healthcare field

Master's degree (preferred)

Job description

Clinical Management Consultants seeks a Health Plan Utilization Management Manager for the Willamette Valley near Eugene. You will lead a team responsible for timely, well-informed care decisions, collaborating with physicians, care managers, and provider relations staff.

The role entails supervising daily UM operations, optimizing processes, and ensuring consistency with medical necessity criteria. A bachelor's in nursing or related healthcare field plus leadership experience is required;