Utilization Management Manager

🕒 July 27

🇺🇸 United States – Remote

💵 $115k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 16%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Intus Care

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

📣 Marketing

📦 Logistics

💰 $13.1M Venture Round on 2023-01

Consulting • Marketing • Logistics

Intus Care is a healthcare analytics platform that synthesizes healthcare data to identify risks, visualize trends, and optimize care. The company empowers long-term care providers to deliver more effective care to older adults by predicting high-risk patients, reducing expenditures through early risk detection, and improving organizational performance using data-driven insights. Intus Care is particularly beneficial for PACE (Programs of All-Inclusive Care for the Elderly) organizations, providing tools that enable care providers and executives to make informed decisions and proactively manage patient care based on real-time analytics.

📋 Description

• Own end-to-end delivery and performance of the utilization management program for PACE clients • Ensure UM service-level agreements, authorization turnaround times, dispute timelines, documentation completeness, and quality benchmarks are met • Establish and report individual and team performance metrics; conduct one-on-ones, reviews, and coaching • Ensure consistent application of PACE authorization policies, procedures, and clinical decision support criteria • Design and lead quality assurance and inter-rater reliability activities • Manage staffing, scheduling, workload distribution, case assignments, and PTO coverage • Recruit, onboard, and develop UM nurses; build training and ramp plans • Maintain UM policies, procedures, workflows, and job aids; communicate and audit changes • Partner with the Contracted Physician on escalation pathways and clinical decision support • Analyze care patterns, cost drivers, length-of-stay trends, denial and overturn rates, and utilization efficiency • Lead performance improvement initiatives and present program reporting to leadership and PACE stakeholders • Personally handle UM reviews, hospital admissions, subacute and SNF admissions, transitions of care, and retrospective reviews • Lead complex provider disputes and coordinate clinical review with finance, claims adjudication, and the Contracted Physician • Partner with PACE organizations, Medical Directors, IDTs, and provider networks on authorization decisions and care strategies • Facilitate education, training, and cross-functional collaboration • Serve as a primary client-facing point of contact for UM program performance

🎯 Requirements

• Current, active Registered Nurse (RN) license in good standing • 7+ years of utilization management experience, including risk-based, integrated care models • 5+ years of direct people-management experience leading clinical reviewers or UM nurses, with accountability for team SLAs and performance outcomes • Experience owning and improving inter-rater reliability, QA programs, and consistent application of clinical decision support criteria such as MCG or InterQual • Strong data literacy and ability to use dashboards and analytics to diagnose performance gaps and drive interventions • Ability to manage competing priorities in a fast-paced, performance-driven environment • Excellent written and verbal communication skills, including presenting to executive and client audiences • Certification in case management or utilization review is preferred, such as CCM, ACM, or CPHM • Experience implementing or scaling UM operations across multiple client organizations or sites is preferred • Experience with PDSA, Lean, or Six Sigma is preferred • Position is not eligible for sponsorship