Utilization Management Leader — Health Plan (Remote/Hybrid)

Clinical Management Consultants; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Hybrid or remote work

Annual in-person conference in Oregon

Job summary

Clinical Management Consultants in Oregon’s Willamette Valley seeks a Health Plan Utilization Management Manager to lead the team that ensures timely, well-informed care decisions for members, working with providers, care managers, and physician leaders.

You’ll oversee daily reviews, coach staff, and apply medical necessity criteria consistently. This role offers hybrid or remote work with an annual in-person conference in Oregon.

Qualifications

• Bachelor’s degree in nursing or related healthcare field required.
• At least 3 years supervisory or team leadership experience.
• Minimum 2 years UM program leadership and 2 years Oregon Medicaid experience.

Responsibilities

• Oversee daily utilization management review operations.
• Directly supervise the UM team and monitor performance.
• Collaborate with physician leaders, care managers, and provider relations.
• Drive process improvements and ensure compliance with Medicaid requirements.

Skills

Supervisory

Leadership

Clinical background

Education

Bachelor's in Nursing

Master's degree

Job description

Clinical Management Consultants in Oregon’s Willamette Valley seeks a Health Plan Utilization Management Manager to lead the team that ensures timely, well-informed care decisions for members, working with providers, care managers, and physician leaders.

You’ll oversee daily reviews, coach staff, and apply medical necessity criteria consistently. This role offers hybrid or remote work with an annual in-person conference in Oregon.