Utilization Management Manager

Utilization Management Manager Somerville, MA Job Details Full-time $65 - $68 an hour 1 day ago Qualifications Collaborate with healthcare professionals Clinical program implementation Medicare Healthcare resource management Electronic health records (EHR) management RN License Caseload management Regulatory compliance Mid-level Improving operational efficiency Performance management Master's degree Analysis skills Supervising experience Bachelor's degree Continuous improvement Team management Utilization management Quality improvement Mentoring Clinical documentation Data interpretation Healthcare team management Training Care coordination Leadership 2 years Healthcare compliance Communication skills

Full Job Description Utilization Management Manager Overview:

Join our client, a leader in innovative healthcare solutions, as a Utilization Management Manager. This vital role offers an exciting opportunity to oversee clinical activities that ensure high-quality, efficient resource utilization for Medicare Advantage and DSNP members. Be at the forefront of transforming patient care and operations within a dynamic, supportive environment committed to excellence and continuous improvement.

Compensation:

$65.00 - $68.00 per hour

Responsibilities:

Lead and mentor a team of care coordinators and case managers, ensuring adherence to clinical standards and protocols. Design and execute strategies to boost the efficiency and quality of clinical care coordination efforts. Monitor and evaluate patient care activities and outcomes to maintain compliance with regulatory and organizational policies. Foster collaboration among clinical teams, physicians, and healthcare providers to enhance patient care delivery. Analyze patient data to detect trends, identify improvement opportunities, and guide intervention strategies. Conduct performance assessments and promote ongoing training for team members. Manage caseload assignments, prioritizing patient cases based on acuity and available resources. Oversee the adoption of new care models or technological solutions to advance patient outcomes and operational workflows. Maintain accurate documentation and report on case management activities and patient care results.

Requirements:

Bachelor's degree in a related field is required; a Master's degree is preferred. Valid Massachusetts RN license is essential A minimum of 3-5 years of clinical care coordination or case management experience. At least 2-3 years of supervisory or leadership experience. 2-3 years of Medicare and DSNP utilization management expertise. Demonstrated leadership and team management capabilities. Exceptional communication and interpersonal skills for effective collaboration. Strong analytical skills for assessing patient care data and driving improvements. Ability to resolve complex coordination challenges and implement impactful solutions. Familiarity with healthcare regulations and best practices in clinical management. Proficiency with healthcare management software and electronic health record systems. Our Commitment to Inclusion & Belonging The Hollister Group is an equal opportunity employer. We welcome and encourage applications from people who are under-represented in their respective occupation or position. #HGP #LI-KM1