Utilization Operations Manager - Remote Leadership

ISHE; Pearland (TX); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Remote work flexibility

Comprehensive benefits package

Job summary

Kelsey-Seybold Clinic, part of the Optum family, seeks a Senior Manager to lead non-clinical Utilization Management support services across a major Texas location. You will oversee authorization intake, provider inquiries, and operational workflows, while driving efficiency and compliance with CMS requirements.

The role emphasizes leadership, analytics, and collaboration with clinical and IT stakeholders to improve provider and member services.

Qualifications

• Bachelor's degree required.
• 5+ years of supervisory or management experience in healthcare operations.
• Managed Care experience.
• Experience supervising administrative healthcare teams.
• Experience in workforce management.
• Experience in operational reporting.
• Experience in process improvement.
• Experience in Microsoft Office Suite.
• Strong written and verbal communication.
• Strong organizational and analytical skills.
• Strong interpersonal and leadership skills.
• Ability to manage multiple priorities simultaneously.

Responsibilities

• Oversees daily administrative Utilization Management operations.
• Supervises Utilization Operations Supervisors and Utilization Management Representatives.
• Oversees authorization intake, provider inquiries, work queues, correspondence, administrative support, and operational workflow management.
• Reviews operational reporting, universes, productivity metrics, work queue aging, staffing trends, and dashboards to identify improvements.
• Implements workflow redesign, automation, and operational improvements to increase efficiency.
• Develops staff through coaching, performance management, and leadership development.
• Serves as primary operational escalation point for administrative issues.
• Ensures compliance with CMS, delegated health plan requirements, internal policies, and procedures.
• Reviews universes, delegation evidence, audit documentation, and reporting accuracy.
• Identifies trends and develops corrective action plans.
• Oversees quality monitoring and reporting accuracy.
• Supports audit readiness and delegation oversight activities.
• Provides ongoing staff development through onboarding and mentoring.

Skills

Supervision experience

Workforce management

Operational reporting

Process improvement

Microsoft Office

Communication

Leadership

Education

Bachelor's degree

Master's degree

Tools

Microsoft Office Suite

Epic

Power BI

Job description

Kelsey-Seybold Clinic, part of the Optum family, seeks a Senior Manager to lead non-clinical Utilization Management support services across a major Texas location. You will oversee authorization intake, provider inquiries, and operational workflows, while driving efficiency and compliance with CMS requirements.

The role emphasizes leadership, analytics, and collaboration with clinical and IT stakeholders to improve provider and member services.