Manager Utilization Management
About The Position
Full Time, Monday-Friday 8:00 - 5:30 p.m. Holiday and weekend coverage when needed. The Manager of Care Management I leads and collaborates with care management operations across utilization review, acute and emergency department care, and ambulatory/community settings, ensuring alignment with broader system-level strategies. This role oversees multiple disciplines at various care sites within a market or region, working collaboratively with medical staff, nursing, clinical, and revenue cycle leaders to optimize patient care and financial performance. Responsible for managing departmental services, including social work and complex care planning, transitions of care, and utilization management. The position ensures compliance with state, national, and regulatory requirements while fostering workforce development. The manager plays a crucial role in shaping enterprise-wide strategies to deliver safe, high-quality, patient-centered, and equitable care. Additionally, this role may require travel to various locations for operational oversight and leadership support. Scope: This position manages a department with operations primarily Monday through Friday (may include weekend support for escalations) in non-24-hour service areas, regardless of the size of the facility, or has a small number of direct reports in 24-hour departments of medium or large facilities due to specific reporting structure considerations. Oversee operations of staffing, escalations, barrier triage, and coordination with compliance and legal to support care delivery. The Manager Care Management I reports to the Care Management Director. Position Details Full Time Monday - Friday, 8:00 - 5:30 Occasional weekend or holiday coverage Possibility of remote work some days Main Location - Nevada Central Office in Las Vegas, must be local. 7 days a week, holidays/weekends remote
Requirements
- Current Registered Nurse (RN) license in state of practice OR Licensed Clinical Social Worker (LCSW)/Licensed Master of Social Work (LMSW) or applicable license in state of practice with relevant experience at this licensure.
- Bachelor of Science in Nursing (BSN) OR Master of Social Work (MSW) from an accredited institution (degree verification required).
- Care Management Certification within 24 months of hire or promotion.
- Demonstrated care management experience.
- Authorization or Utilization Management experience.
- Leadership experience.
Nice To Haves
- Previous management experience in hospital care management, utilization review, ambulatory care management, ambulatory utilization review, or related area.
Responsibilities
- Patient Experience & Advocacy: Drives patient satisfaction programs and mentors staff in service excellence.
- System-Wide Collaboration: Represents care management with healthcare executives, post-acute providers, multidisciplinary teams, and outreach programs to improve care transitions and service integration.
- Process Improvement Leadership: Drives high-impact change initiatives, monitors key performance indicators, and leads quality assurance efforts.
- Change Management: Leads strategic initiatives to support enterprise KPI's and outcomes, manages transitions, and involves staff in decision-making.
- Continuous Improvement: Implements best practices, drives quality enhancements, and optimizes operational effectiveness.
Benefits
- We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
- Learn more about our comprehensive benefits package here .
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
11-50 employees
