Manager of Utilization Management and Complex Care Management

AbsoluteCARE Medical and Pharmacy-posted about 1 year ago

Full-time • Manager

Dayton, OH

Resume

Match Score

Upload and Match ResumeTrack Jobs with Teal

The Manager of Utilization Management and Complex Care Management is responsible for providing operational leadership for the Utilization Management, Transitional Care, and Care Management teams. This role focuses on improving health outcomes, reducing healthcare costs, and facilitating effective care transitions for complex populations. The Manager collaborates with various stakeholders to ensure a seamless continuum of care and oversees team performance, staff development, and adherence to care management standards.

Lead and manage a diverse care management team, including registered nurses, social workers, and community health workers.
Oversee staff development and ensure adherence to care management standards, including person-centered care planning and documentation protocols.
Conduct performance management activities, including case audits and one-on-one coaching.
Manage caseloads to ensure follow-up and compliance with organizational requirements.
Coordinate with community-based organizations and primary care providers to address members' chronic care needs.
Host and document interdisciplinary care team meetings to enhance member outcomes.
Use data and reporting to monitor team performance and drive improvements in utilization and member satisfaction.
Identify low-performing staff or processes and implement improvement plans as needed.
Serve as a subject matter expert on care management and chronic conditions, leading training and promoting best practices.
Develop and maintain relationships with payors and community organizations to support integrated member care.
Conduct interviews, hiring, onboarding, and training for new team members.

Current, active, and unrestricted license in a health or human services discipline (e.g., RN, SW).
Qualified with CCM Credentials or obtain within 24 months of hire.
Bachelor's degree in health or human services discipline required; Master's degree preferred.
7-10 years' experience, with at least 3-5 years in leadership, ideally in Value-Based Care or Utilization Management.
Experience with complex populations, including Medicaid and Medicare.
Proficiency with evidence-based care transition strategies.
Advanced computer skills in Microsoft Office Suite and EHR systems.
Strong data analysis and reporting abilities.
Excellent verbal and written communication skills.

Master's degree in business, Healthcare Administration/Public Health, Finance, or a related field.
Advanced clinical practice credentials (e.g., CNS/APN, LCSW/LISW, PsyD/PhD).
Other certifications such as CMAC, CHE, CPHQ.

Remote work options
Comprehensive health benefits
Professional development opportunities
Employee engagement programs

Track Jobs with Teal

Job Search Resources

•

Resume Builder

•

Resume Examples

•

Cover Letter Examples

Manager of Utilization Management and Complex Care Management

Job Search Resources

Tools

Career Hubs

Guides

Company