Utilization Management (UM) Program Manager

$1 - $1,000,000 / year

Description

The Utilization Management (UM) Program Manager plays a vital role in driving the strategic planning, execution, and continuous enhancement of UM programs. The position ensures the delivery of clinically appropriate and cost-effective care by optimizing utilization management processes across the organization.

Key Responsibilities:

Lead and manage UM programs to align with organizational goals for quality, efficiency, and compliance.
Collaborate closely with clinical UM, Care Management, Quality, Information Technology (IT), and other key stakeholders, to streamline authorization workflows and improve operational efficiency
Develop and implement strategies to reduce avoidable denials and enhance patient throughput
Ensure adherence to regulatory and accreditation standards through Effective program oversight and compliance monitoring
Coordinate complex, multi work stream initiatives that involve cross functional teams
Utilize data analytics to inform decision making, identify opportunities for improvement, and measure program outcomes
Standardize UM processes, tools, and documentation to promote consistency and scalability
Facilitate communication and change management efforts to support successful program adoption and sustainability
Support other clinical departments as needed to advance organizational objectives

Salary Range: $70,900-$145,200/annually

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