Manager, Utilization Operations - Remote

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties.

Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Provides leadership and operational oversight for all non-clinical Utilization Management support services including authorization intake, utilization representatives, provider inquiries, work queue management, administrative correspondence, delegation support activities, operational reporting, and workflow management. Oversees supervisors and administrative staff while ensuring timely, accurate, compliant, and efficient operational support for Utilization Management services.

Provides leadership for operational reporting, universe review, data validation, workflow optimization, quality monitoring, delegation support, and operational analytics. Continuously evaluates administrative workflows, staffing performance, operational metrics, work queues, and reporting trends to proactively identify operational risks, inefficiencies, and opportunities for improvement while implementing sustainable solutions that enhance departmental performance and reduce turnaround times.

Partners collaboratively with clinical leadership, operational leadership, Information Technology, Quality, Regulatory Affairs, and delegated health plans to improve administrative efficiency, strengthen compliance, support audit readiness, and deliver exceptional provider and member service.

If you are located in Pearland, TX, you will have the flexibility to work remotely
* as you take on some tough challenges.

• Performance
  • Oversees daily administrative Utilization Management operations
  • Supervises Utilization Operations Supervisors and Utilization Management Representatives
  • Oversees authorization intake, provider inquiries, work queues, correspondence, administrative support, and operational workflow management
  • Reviews operational reporting, universes, productivity metrics, work queue aging, staffing trends, and operational dashboards to proactively identify improvement opportunities
  • Implements workflow redesign, automation, and operational improvements that increase efficiency while reducing manual effort
  • Develops staff through coaching, performance management, and leadership development
  • Serves as primary operational escalation point for administrative issues
  • Compliance & Internal Quality
  • Ensures compliance with CMS, delegated health plan requirements, internal policies, and operational procedures
  • Reviews operational universes, delegation evidence, audit documentation, and reporting accuracy
  • Identifies operational trends and develops corrective action plans before issues require escalation
  • Oversees quality monitoring, documentation accuracy, and operational consistency
  • Supports audit readiness and delegation oversight activities
• Timelines
  • Ensures administrative work queues meet established internal turnaround time expectations
  • Responds to provider inquiries, delegation requests, operational investigations, and administrative escalations with same-business-day acknowledgement and timely resolution
  • Monitors staffing capacity and work queue aging to prevent delays
  • Coordinates timely completion of reporting, operational deliverables, and administrative requests
• Other
  • Supports implementation of new technologies, workflows, operational initiatives, and reporting enhancements
  • Participates in committee meetings, cross-functional work groups, and organizational initiatives
  • Develops staff through onboarding, mentoring, education, and coaching
  • Performs additional duties as assigned by the Senior Manager, Utilization Management

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Bachelor's Degree
• 5+ years of supervisory or management experience in healthcare operations environment or related field
• Managed Care experience
• Experience supervising administrative healthcare teams
• Experience in workforce management
• Experience in operational reporting
• Experience in process improvement
• Experience in Microsoft Office Suite
• Proven solid written and verbal communication
• Proven solid organizational and analytical skills
• Proven excellent interpersonal and leadership skills
• Demonstrated ability to manage multiple priorities simultaneously

• Master's degree
• Lean Six Sigma Green Belt
• PMP Certification
• Medicare Advantage experience
• Delegation Oversight…