Manager of Utilization Management I

Elevance Health • Tampa, FL

2d • Hybrid

About The Position

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Must reside in the state of Florida The Manager of Utilization Management is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. How you'll make a difference: Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions. Coordinates service delivery to include member assessment of physical and psychological factors. Partners with providers to establish short and long term goals that meet the members needs, functional abilities, and referral sources requirements. Identifies members with potential for high risk complications. Reviews benefit systems and cost benefit analysis. Evaluates medical, mental health and substance abuse service for cost containment. Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes. Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements

• Requires BA/BS and minimum of 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN, PA, LSW, LCSW, LPC, LMHC or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply is required.

Nice To Haves

• MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
• Certified Case Manager Certification preferred.

Responsibilities

• Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
• Coordinates service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short and long term goals that meet the members needs, functional abilities, and referral sources requirements.
• Identifies members with potential for high risk complications.
• Reviews benefit systems and cost benefit analysis.
• Evaluates medical, mental health and substance abuse service for cost containment.
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees