Utilization Management Leader – Hybrid Role

Cambia Health; Little Rock (AR); Hybride; USD 105 000 - 172 000; Plein temps

Résumé du poste

Cambia Health is seeking a Manager Utilization Management to lead a team across prospective, concurrent, retrospective reviews and post-service claims audit. The hybrid role requires 3 days in office with flexibility to collaborate across multiple offices including Little Rock and Springdale.

You will develop policies, oversee staff performance, manage budgets, and drive quality and outcomes in utilization management.

Qualifications

• Bachelor's degree in nursing or related field; masters preferred.
• Minimum 5 years of clinical care experience.
• Minimum 5 years of leadership experience.
• 7 years of insurance industry experience or equivalent.
• Current unrestricted RN licensure in the United States

Responsabilités

• Lead the development and execution of utilization and/or payment review policies, procedures and standards.
• Oversee the implementation of policy updates or process improvements as needed.
• Handle management responsibilities for staff, including performance reviews and development.
• Develop supervisors and participate in talent management activities.
• Monitor results and metrics; ensure compliance with standards.
• Collaborate with leaders across departments to resolve issues.
• Manage department budget and resources; oversee project plans.
• Establish long-term goals and adapt operational plans as needed.
• Create visibility and support for utilization management programs.

Connaissances

Leadership

Project management

Team development

Communication

Insurance trends

Clinical management

Formation

Bachelor's degree in nursing or related field

Master's preferred

Registered Nurse licensure (RN)

Description du poste

Cambia Health is seeking a Manager Utilization Management to lead a team across prospective, concurrent, retrospective reviews and post-service claims audit. The hybrid role requires 3 days in office with flexibility to collaborate across multiple offices including Little Rock and Springdale.

You will develop policies, oversee staff performance, manage budgets, and drive quality and outcomes in utilization management.