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.

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