Manager Utilization Management

Manager Utilization Management Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale offices. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate.

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Every day, Cambia’s dedicated team of Clinical leaders are living our mission to make health care easier and lives better. As a member of the Utilization Management leadership team, our Manager Utilization Management Plans, directs, and manages the activities of the utilization management professional and support staff. Oversees staff directly or through subordinate supervisor(s). Provides leadership to set performance standards and ensure effective and efficient execution of utilization management programs across all Cambia plans, including prospective, concurrent, retrospective review and/or post service claims review and bill audit procedures.

Represents the department in interactions with all levels of management, vendor partners, clients, providers, government officials, and outside consultants – all in service of making our members’ health journeys easier. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Do you want to lead a team where your decisions directly impact making health care easier for thousands of members every single day? Would you thrive in a leadership role where you collaborate across all organizational levels—from frontline staff to government officials—to drive meaningful change in health care? Then this role may be the perfect fit.

• 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

• 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

• 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,…