Manager Utilization Management

Job Description

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.

• 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

• 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.

• Care Management
• Leadership
• Accountability
• People Management
• Financial Acumen
• Data Analysis & Reporting
• Coaching & Mentoring
• Strategic Planning
• Continuous Improvement
• Scheduling

• 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.

• Previous management experience in hospital care management, utilization review, ambulatory care management, ambulatory utilization review, or related area.

• Ongoing need to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.
• Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication…