Manager Utilization Management

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
• #LI-Hybrid
• 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 and Lewiston, ID; Salt Lake City, UT, Oregon and Washington. The full salary range is $105,000 - $172,000 and the bonus target is 17%. The expected salary range is $112,200 - $151,800.
• Regional pay structure — applies to North Dakota and Idaho and Utah locations outside the metro areas listed above: The full salary range is $95,000 - $155,000 and the bonus target is 17%. The expected salary range is $101,000 - $136.600.

About Cambia

Preferred Qualifications

• Bachelor's degree in nursing or related field, masters preferred
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
• National pay structure — applies to the Boise and Lewiston, ID; Salt Lake City, UT, Oregon and Washington. The full salary range is $105,000 - $172,000 and the bonus target is 17%. The expected salary range is $112,200 - $151,800.
• Regional pay structure — applies to North Dakota and Idaho and Utah locations outside the metro areas listed above: The full salary range is $95,000 - $155,000 and the bonus target is 17%. The expected salary range is $101,000 - $136.600.