Manager Utilization Management

Manager Utilization Management

Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate.

Who We Are Looking For

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.

What You Bring to Cambia

Qualifications

• 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

Skills and Attributes

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

What You Will Do at Cambia

• 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.

FTEs Supervised

• 10-15

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

National pay structure — applies to the Boise, Portland, Salem, Seattle/Renton/Tacoma, Burlington, Vancouver, Lewiston, and Salt Lake City metro areas: The expected hiring range is $112,200 - $151,800, the full salary range is $105,000 - $172,000 and the bonus target is 17%.

Regional pay structure — applies to North Dakota and to Idaho, Oregon, Washington, and Utah locations outside the metro areas listed above: The expected hiring range is $100,980 - $136,620, the full salary range is $95,000 - $155,000 and the bonus target is 17%.