Manager Utilization Management

Cambia Health Solutions • Medford, OR

1d • $95,000 - $172,000 • Hybrid

About The Position

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Clinical leaders are living our mission to make health care easier and lives better. As a member of the Utilization Management leadership team, our Manager Utilization Management Plans, directs, and manages the activities of the utilization management professional and support staff. Oversees staff directly or through subordinate supervisor(s). Provides leadership to set performance standards and ensure effective and efficient execution of utilization management programs across all Cambia plans, including prospective, concurrent, retrospective review and/or post service claims review and bill audit procedures. Represents the department in interactions with all levels of management, vendor partners, clients, providers, government officials, and outside consultants – all in service of making our members’ health journeys easier. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Do you want to lead a team where your decisions directly impact making health care easier for thousands of members every single day? Would you thrive in a leadership role where you collaborate across all organizational levels—from frontline staff to government officials—to drive meaningful change in health care? Then this role may be the perfect fit.

Requirements

• Bachelor's degree in nursing or related field, masters preferred
• 5 years of clinical care experience
• 5 years of leadership experience
• 7 years of insurance industry experience or equivalent combination of education and experience
• Current unrestricted Registered Nurse (RN) Licensure, in a state or territory of the United States
• Ability to identify issues, opportunities, and effective solutions and collaborate with other departments to improve processes and/or results.
• Demonstrated competency in resource and project management: budgeting, organizing work, providing leadership to staff, establishing measures for success, and managing to deliverables.
• Ability to develop and lead a team including: hiring, goal setting, coaching and development (including supervisors and/or employees who may be in multiple locations or work remotely).
• Ability to communicate effectively, verbally and in writing, including meeting facilitation and presentations with employer or provider groups.
• Familiarity with health insurance industry trends and technology.
• Demonstrated competency in clinical case management and utilization management practices.
• Experience with statistical analysis and their application in utilization management programs.
• Willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Leads the development and execution of effective utilization and/or payment review management policies, procedures and standards.
• Oversees the implementation of policy updates or process improvements as needed to ensure quality and service excellence.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Develops supervisors and participates in talent management activities.
• Regularly communicates organizational objectives and team goals.
• Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
• Collaborates with other leaders and across departments to resolve issues.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
• In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.
• Creates visibility and support for utilization management and/or payment review programs.
• Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.
• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.
• May develop and present educational updates to other departments.
• Oversees development and implementation of department programs.
• Responsible for program quality and successful outcomes of programs.
• As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager