Utilization Management Leader — Hybrid Healthcare Ops

Cambia Health Solutions; Arkansas; Hybrid; USD 105,000 - 172,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account contribution

Generous paid time off

401(k) with company match

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking a dynamic Utilization Management leader to guide a team of professionals across prospective, concurrent, and post-service review for multiple plans. The role oversees staff, sets performance standards, and partners with management, vendors, and providers to improve outcomes.

As a people leader, you will mentor supervisors, manage budgets, and drive policy execution while maintaining clinical excellence and staying current with industry trends and AI-enabled

Qualifications

• Bachelor's degree in nursing or related field; master's preferred.
• 5 years of clinical care experience.
• 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.
• Current unrestricted RN licensure in a U.S. state or territory.

Responsibilities

• Lead development and execution of utilization management policies and standards.
• Oversee staff performance reviews, coaching, and development.
• Monitor results and ensure compliance with standards and regulations.
• Manage department budget, resources, and project plans.
• Provide education and communication about programs to internal and external stakeholders.

Skills

Leadership

Clinical care

Staff development

Communication

Health insurance knowledge

Clinical case management

Statistical analysis

AI tools

Budgeting

Project management

Education

Bachelor's degree in nursing or related field

Master's degree preferred

Tools

AI tools

Job description

Cambia Health Solutions is seeking a dynamic Utilization Management leader to guide a team of professionals across prospective, concurrent, and post-service review for multiple plans. The role oversees staff, sets performance standards, and partners with management, vendors, and providers to improve outcomes.

As a people leader, you will mentor supervisors, manage budgets, and drive policy execution while maintaining clinical excellence and staying current with industry trends and AI-enabled