Manager, Utilization Management – Coordination
Alignment Health
full-time
Posted on:
Location Type: Hybrid
Location: Orange • California • 🇺🇸 United States
Visit company websiteSalary
💰 $70,823 - $106,234 per year
Job Level
Mid-LevelSenior
About the role
- Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows.
- Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions.
- Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels.
- Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs.
- Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards.
- Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity.
- Lead root-cause analyses for escalated operational issues and coordinate corrective action plans.
- Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making.
- Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices.
- Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques.
- Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions.
- Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards.
- Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans.
- Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements.
- Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required.
- Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership.
- Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables.
- Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance.
- Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution.
- Collaborate with network providers and internal teams to clarify authorization processes and ensure alignment with benefit and policy criteria.
- Participate in internal workgroups or initiatives to improve system functionality, workflow automation, and reporting enhancements.
- Assist with the development, implementation, and monitoring of UM-related initiatives and special projects (e.g., claims review process, continuity-of-care tracking, or performance optimization programs).
- Evaluate and revise UM policies and procedures to align with evolving regulatory standards and organizational goals.
- Support readiness activities for CMS audits and other accreditation requirements.
- Perform other related functions and special assignments as directed by senior leadership.
Requirements
- Minimum (4) years of related experience in a managed care setting
- Minimum (3) years of recent and related supervisory experience
- Strong knowledge of Medicare Managed Care Plans
- Proficient in Microsoft Word, Excel, and Outlook; advanced Excel skills preferred (pivot tables, formulas, data visualization, and reporting functions for performance tracking and analysis)
- Experience leading and sustaining process improvement initiatives within healthcare operations to enhance efficiency, compliance, and service quality.
- Excellent written and verbal communication skills; able to build and maintain collaborative relationships with diverse teams, including leadership, staff, and external partners.
- Strong analytical thinking with the ability to define problems, collect and interpret data, establish facts, draw valid conclusions, and develop actionable solutions.
- Demonstrated ability to prioritize multiple tasks, manage time effectively, and maintain accuracy in a fast-paced, dynamic environment.
- Ability to interpret, analyze, and present statistical and operational reports to support decision-making and performance monitoring.
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
operational leadershipauthorization processingreferral routingperformance metrics analysisroot-cause analysistraining material developmentprocess improvementdata analysispolicy evaluationperformance optimization
Soft skills
staff managementcoachingcommunicationanalytical thinkingtime managementcollaborationproblem-solvingmentoringprioritizationrelationship building