Utilization Management Leader — Hybrid

Cambia Health Solutions; Vancouver (WA); Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Work from home options

401(k) match

Bonuses

Paid time off

Job summary

Cambia Health Solutions seeks an experienced Utilization Management leader to guide policy, staff development, and program quality. The role spans prospective, concurrent, and post-service reviews, impacting thousands of health journeys daily.

You will lead a team of professionals, manage budgets, and collaborate across departments and vendors to ensure high standards and compliant outcomes. Hybrid work options available.

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 combination of education and experience.
• Current unrestricted Registered Nurse (RN) Licensure, in a state or territory of the United States.

Responsibilities

• Leads the development and execution of effective utilization and/or payment review management policies, procedures and standards.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
• In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.
• Creates visibility and support for utilization management and/or payment review programs. Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.
• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.
• Oversees development and implementation of department programs. Responsible for program quality and successful outcomes of programs.

Skills

Leadership

Clinical care

Problem solving

Communication

Health insurance

Education

Bachelor's degree (nursing or related)

Master's degree preferred

Tools

AI tools

Job description

Cambia Health Solutions seeks an experienced Utilization Management leader to guide policy, staff development, and program quality. The role spans prospective, concurrent, and post-service reviews, impacting thousands of health journeys daily.

You will lead a team of professionals, manage budgets, and collaborate across departments and vendors to ensure high standards and compliant outcomes. Hybrid work options available.