Manager, Utilization Management

The Manager of Utilization Management is responsible for overseeing day-to-day operations across multiple client UM projects. This role combines project management with hands-on leadership of clinical teams, ensuring compliance, performance, and client satisfaction. The manager serves as a resource and SME to internal teams and acts as the key point of contact for client leadership., * Lead and manage assigned UM projects, including oversight of W2 and 1099 nurse teams.

• Serve as the UM subject matter expert and escalation point for clinical guidance.
• Act as the primary liaison to client leadership, providing updates and demonstrating value.
• Ensure productivity, audit compliance, turnaround times, and quality standards are met.
• Conduct regular audits and coach team members to maintain clinical excellence.
• Support staffing alignment and placement strategies with internal leadership.
• Monitor team engagement and proactively manage to reduce turnover.
• Deliver performance reporting and insights to internal and external stakeholders.
• Support onboarding and training of new team members.
• Partner with SVP to identify areas for process improvement and operational efficiency.

Competencies:

• Leads by example, motivates others, and manages team dynamics effectively.
• Thrives in fast paced, evolving environments and adjusts quickly to changing client needs.
• Applies sound clinical reasoning to support decision making and guidance.
• Builds trust with clients, anticipates their needs, and delivers high value outcomes.
• Sets clear expectations, measures performance, and takes ownership of outcomes.
• Works cross functionally with internal teams and client stakeholders to achieve aligned goals.
• Anticipates challenges, investigates root causes and develops solutions.
• Provides regular feedback and mentors team.
• Champions operational efficiency.

Do you have experience in Utilization review?, * Minimum 5 years of Utilization Management experience.

• At least 2 years of leadership or team management in a UM setting.
• Active, unrestricted RN license required
• Strong understanding of InterQual and/or MCG criteria.
• Experience managing remote clinical teams across multiple engagements
• Familiarity with Medicare, Medicaid, and commercial payer UM requirements.
• Excellent communication, data analysis, and problem-solving skills.

Preferred education, certifications and/or experience:

• Consulting or project-based experience preferred.

Physical Requirements/Work environment:

• Remote role with occasional travel (Less than 5%)
• Must have a home office, mobile phone, computer with security requirements met.
• Prolonged periods of sitting at a desk and working on a computer.
• Ability to speak, hear, and comprehend both written and verbal communications., * Utilization Management: 5 years (Required)
• leadership (UM setting): 2 years (Required)

License/Certification:

• RN License (Required)

2.42.4 out of 5 stars Remote $100,000 - $130,000 a year - Full-time, Pulled from the full job description

• 401(k)
• Health insurance
• Paid time off
• Vision insurance
• Dental insurance, * 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance