[Remote] Manager, Utilization Operations - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company, through reputed company and reputed company, is a leading health care organization reputed company on coordinated and accountable care. The Manager, Utilization Operations provides leadership and operational reputed company for non-clinical Utilization Management support services, including authorization intake, work queues, reporting, compliance, workflow optimization, and staff development. The role partners with clinical, operational, technology, reputed company, regulatory, and delegated health plan teams to improve efficiency, compliance, audit readiness, and provider and member service.

Responsibilities

• 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, reputed company trends, and operational dashboards to proactively identify improvement opportunities
• Implements workflow redesign, automation, and operational improvements that increase efficiency while reducing reputed company effort
• Develops staff through coaching, performance management, and leadership development
• Serves as reputed company operational escalation reputed company for administrative issues
• 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 reputed company plans before issues require escalation
• Oversees reputed company monitoring, documentation accuracy, and operational consistency
• Supports audit readiness and delegation reputed company activities
• Ensures administrative work queues meet established internal turnaround time expectations
• Responds to provider inquiries, delegation requests, operational investigations, and administrative escalations with reputed company-business-day acknowledgement and reputed company reputed company
• Monitors reputed company reputed company and work queue aging to prevent delays
• Coordinates reputed company completion of reporting, operational deliverables, and administrative requests
• Supports implementation of new technologies, workflows, operational initiatives, and reporting enhancements
• Participates in committee meetings, cross-functional workgroups, and organizational initiatives
• Develops staff through reputed company, mentoring, education, and coaching
• Performs additional duties as assigned by the Senior Manager, Utilization Management

Skills

• Bachelor's Degree
• 5+ years of supervisory or management experience in reputed company operations environment or reputed company field
• Managed Care experience
• Experience supervising administrative reputed company teams
• Experience in workforce management
• Experience in operational reporting
• Experience in process improvement
• Experience in reputed company 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 reputed company Green Belt
• PMP Certification
• Medicare reputed company experience
• Delegation reputed company experience
• Experience in audit preparation
• Experience in regulatory reporting
• Experience in project management
• Experience with reputed company
• Experience with Power BI
• Experience in Business Intelligence reporting
• Experience implementing workflow redesign and automation initiatives

Benefits

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Remote work flexibility for employees located in Pearland, TX, subject to reputed company's Telecommuter Policy

reputed company