Utilization Management Manager — Remote & Flexible Schedule

Harris Health; Houston (TX); On-site; USD 110,000 - 140,000; Full time

Job summary

Harris Health seeks a Manager, Utilization Management to oversee design, development, and monitoring of system utilization functions. You will balance patient needs with cost-effective resource use, lead UM nursing teams, and drive cross-functional projects with Care Management and payers.

The role involves strategic initiatives, performance measurement, and ensuring alignment with organizational policies and standards across Harris Health's network.

Qualifications

• Nurse with BSN and MSN/health admin or related field.
• Strong background in Case Management, Quality Management, or Coding.
• At least 3 years in Utilization Management and 2 years in supervisory roles.

Responsibilities

• Coordinate UM design, development, implementation, and monitoring to meet clinical and financial goals.
• Lead interdisciplinary care continuity and process improvement projects.
• Manage UM nurses and resources; collaborate with Care Management and third-party payers.
• Make operational and HR decisions within Harris Health policies.

Skills

Analytical

Design

Mathematics

Medical Terms

Utilization review tools

Education

Bachelor's in Nursing

Master's in Nursing/Health Admin/Business/Public Health

Tools

MCG

Change Healthcare (InterQual)

Job description

Harris Health seeks a Manager, Utilization Management to oversee design, development, and monitoring of system utilization functions. You will balance patient needs with cost-effective resource use, lead UM nursing teams, and drive cross-functional projects with Care Management and payers.

The role involves strategic initiatives, performance measurement, and ensuring alignment with organizational policies and standards across Harris Health's network.