Manager of Utilization Management

The Manager of Utilization Management (MUM) is a key member of the integrated community care team (ICCT) at AbsoluteCare, responsible for providing clinical and performance oversight of a transitional care management team comprised of registered nurses. The MUM understands the level of care and medical necessity process, discharge planning, care coordination, and integrated case management supports for members currently admitted at an inpatient facility. This role involves close collaboration with the center medical director and the Program Manager of Utilization Management to identify and implement integrated processes to improve outcomes. The MUM oversees daily operations of the utilization management and transitional care management team, ensuring compliance with internal and NCQA standards, conducting case file audits, and leading team meetings to maintain morale. The effectiveness of the MUM is measured by value-based care outcomes including member engagement, admission and readmission rates, length of stay, bed days, and hospital follow-up completion rates.