Utilization Management Ops Leader: Market Excellence

CareSource; United States; Remote; USD 83,000 - 133,000; Full time

Job summary

CareSource in the United States seeks a Utilization Management Market Operations Manager to oversee UM and Appeals operations, develop policies, review team metrics, prepare statutory reporting, and coordinate audits and annual program requirements.

You will lead cross‑functional teams, drive process improvements, mentor staff, and ensure regulatory compliance while collaborating with clinical leadership and external partners to standardize and improve enterprise performance.

Qualifications

• Associates degree in Nursing or advanced degree in Psychology.
• Experience with analysis, data and reporting is required.
• Demonstrated change management and continuous improvement leadership skills required.

Responsibilities

• Utilize process controls to achieve operational excellence in all areas within the department.
• Oversee and support change management initiatives that impact the department.
• Educate, mentor, and train staff and clinical leaders on requirements, process improvement and quality.
• Manage policy and process changes that result from regulatory/compliance requirements.

Skills

Process improvement

Data analysis

Communication

Time management

Collaboration

Problem solving

Education

Associate degree in Nursing

Advanced degree in Psychology

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Outlook

Visio

Job description

CareSource in the United States seeks a Utilization Management Market Operations Manager to oversee UM and Appeals operations, develop policies, review team metrics, prepare statutory reporting, and coordinate audits and annual program requirements.

You will lead cross‑functional teams, drive process improvements, mentor staff, and ensure regulatory compliance while collaborating with clinical leadership and external partners to standardize and improve enterprise performance.