Manager, Utilization Management Operations - #101402

This position ensures that all decisions made are accurate and complete and is responsible for developing and reporting all trends for management reporting. Additionally, this role ensures that all UM policies and procedures are compliant with CMS requirements.

• Develop and implement effective strategies that enables the department to maintain efficient and cost-effective processes
• Establish and maintain UM Intake processes and systems to ensure data quality to support UST’s quality, production, and financial goals
• Drive operational excellence into all processes and departmental interactions
• Lead employees and other management in developing effective intercompany workflows for different processes
• Lead, coach, develop, and implement training programs to ensure staff competence.
• Operate a departmental audit/oversight program that focuses on continuous quality improvement
• Establish regular reporting to ensure management is made of aware process trends and performance
• Establish a positive working environment that promotes collaboration, transparency, and employee engagement
• Identify innovative methods to improve performance and provider/customer satisfaction
• Instill quality commitment value with team
• Lead standards and process for insuring quality selection and retention of department employees.
• Responsible for balancing workload to optimize the effectiveness of the team
• Directly supervises non-exempt staff in accordance with company policies and applicable geo-specific laws and regulations
• Responsibilities include, but are not limited to, effectively interviewing, hiring, managing performance, training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; and addressing complaints and resolving problems; supporting and encouraging the engagement process

Qualifications:

• Active mainland USRN license
• Three to five years’ experience of progressive responsibility in an insurance or managed care environment. One year supervisory or lead experience in insurance or managed care is required
• Experience in Utilization Management
• Proven problem-solving skills and ability to translate knowledge to corporate departments
• Ability to establish training programs and motivate employees in a quality-minded environment
• Strong leadership skills with the ability to mentor staff and develop teams
• Ability to work with and empower others on a collaborative basis to ensure success of team
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate
• Ability to establish workflows, manage multiple projects, and meet necessary deadlines
• Amenable to working nightshift

For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by our purpose, we partner with our clients from design to operation. Through our nimble approach, we identify their core challenges, and craft disruptive solutions that bring their vision to life. With deep domain expertise and a future-proof philosophy, we embed innovation and agility into our clients’ organizations—delivering measurable value and lasting change across industries, and around the world. Together, with over 29,000 employees in 30 countries, we build for boundless impact—touching billions of lives in the process.