Senior Manager, Utilization Management (UM) Operations

Liberty Dental Plan Careers•Tustin, CA

5d•Hybrid

About The Position

The Senior Manager, Utilization Management (UM) Operations provides strategic and operational leadership to ensure timely, accurate, and compliant processing of authorizations, referrals, and clinical review activities. This role oversees daily UM operations, ensures compliance with service level agreements (SLAs) and regulatory requirements, and partners cross‑functionally to support departmental and organizational goals while maintaining audit readiness across UM functions.

Requirements

Bachelor’s degree in Healthcare Administration, Business, or a related field (or equivalent combination of education and experience)
Minimum 8 years of Utilization Management or healthcare operations experience (dental plan experience preferred)
3–5 years of leadership experience managing UM teams, clinical operations, or high‑volume administrative operations
Proven leadership, staff development, and team‑building abilities
Extensive knowledge of UM processes, preauthorization/referral workflows, and related systems
Excellent organizational, analytical, and writing skills
Strong presentation skills with the ability to communicate effectively with executive audiences
Proficiency with Microsoft Office tools (Word, Teams, Outlook, PowerPoint)
Strong conflict management skills
Ability to work independently while driving strategic direction

Nice To Haves

dental plan experience preferred

Responsibilities

Promote a positive, collaborative, and high‑engagement team culture rooted in trust, continuous learning, and service excellence
Lead, coach, and mentor UM managers and staff to drive effective performance, consistency, and accountability across all UM functions
Oversee recruiting, hiring, onboarding, training, and talent development of UM team members
Define and communicate performance expectations, KPIs, productivity standards, and quality metrics; conduct performance reviews and staff meetings
Address performance and behavioral issues promptly through coaching, feedback, and corrective action when necessary
Maintain visibility into UM inventory and turnaround times and ensure compliance with SLAs at corporate, client, and regulatory levels (CMS, NCQA, URAC)
Ensure departmental adherence to UM processing guidelines, workflows, and policies across teams
Review UM trends, operational data, and case files to identify improvement opportunities and implement best practices
Lead or support automation initiatives, system enhancements, and process redesign to reduce manual work and increase accuracy
Ensure audit readiness and lead responses to internal and external audits, including corrective action plans
Serve as an operational lead and UM subject‑matter expert in cross‑departmental initiatives, issue resolution, process improvements, new implementations, and client onboarding
Partner with analytics and reporting teams to enhance dashboards, scorecards, forecasting models, and operational reporting tools; provide leadership with actionable insights
Lead or support enterprise initiatives such as cost‑containment programs, product expansions, RFP support, operational readiness for new markets, and strategic transformation efforts
Manage special projects as assigned, ensuring clear deliverables, timelines, and communication plans
Perform other duties as assigned while maintaining professionalism, sound judgment, and adaptability

Benefits

Competitive pay structure and savings options
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines
Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-paid dental coverage for employees and eligible dependents
Vision insurance with low-cost premiums for employee-only coverage and dependents
Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage
Flexible Spending Accounts for healthcare and dependent care expenses
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance
Long-term disability coverage
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts
Employee Assistance Program (EAP) to support mental health and well-being
Generous vacation and sick leave policies, with the ability to roll over unused time
10 paid company holidays
Tuition reimbursement for eligible educational expenses
Remote or hybrid work options available for various positions