Manager, UM Operations Strategy – Implementation

CareSource

Manager leading Utilization Management Strategy & Implementation at CareSource. Focusing on compliance and regulatory functions while overseeing healthcare operations.

Posted 5/22/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $83,000 - $132,800 per yearWebsite

About the role

Key responsibilities & impact

The Manager, Utilization Management (UM) Strategy & Implementation leads a dedicated team that supports the UM program through multiple functions with a focus on all regulatory and compliance functions.
Oversee and manage UM Operations oversight functions such as Corrective Action Plan (CAP) management, ongoing monitoring, and multiple audit activities.
Build and leverage effective cross-functional business relationships and influence action across multiple internal and external partners to support a culture of compliance.
Responsible for development and maintenance of documentation related to policy, workflow and process when applicable.
Identify process gaps and drive improvements towards UM compliance in all areas.

Requirements

What you’ll need

Bachelor’s Degree in nursing or related field is required
Master’s Degree in Business or health care field preferred
Minimum of five (5) years clinical or related healthcare industry experience is required
Prior leadership experience is required
Managed Care experience is required
Experience with analysis, data and reporting is required
Accreditation, auditing, and process improvement experience is preferred
Demonstrated change management and continuous improvement leadership skills are strongly desired

Benefits

Comp & perks

Bonus tied to company and individual performance
Total rewards package
Comprehensive well-being support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisreportingprocess improvementauditingaccreditationCorrective Action Plan (CAP) managementcompliance managementworkflow documentationclinical experiencemanaged care

Soft Skills

leadershipcross-functional collaborationinfluencechange managementcontinuous improvementrelationship buildingorganizational skillscommunicationproblem-solvingstrategic thinking