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The Utilization Management (UM) Operations Manager plays a critical role in the successful operationalization and ongoing support of Collective Health's UM program. This position is responsible for developing, implementing, and maintaining efficient UM processes, ensuring regulatory compliance, and providing vital support as the program scales. This is an individual contributor role focused on execution and optimization.

What you'll do:

• Operational Implementation and Support:
• Develop, document, and implement efficient UM operational workflows and procedures.
• Provide ongoing operational support for the UM program, addressing inquiries and resolving issues in a timely manner.
• Support the scaling of the UM program by assisting with the implementation of new processes, technologies, and workflows.
• Collaborate with cross-functional teams to execute a seamless integration of UM operations with other departments, this includes Compliance, Product and Engineering, Clinical, etc.
• Coordinate with UM Program Manager to execute and ensure timely updates to PA lists & UM functions - training, SOPs, KB updates.
• Monitor and action applicable UM reporting
• Attend and participate in Clinical, Operations and Client meetings
• Regulatory Compliance:
• Ensure UM operations are in compliance with all applicable laws and regulations.
• Assist in the development and implementation of policies and procedures to mitigate regulatory risk.
• Process Improvement:
• Continuously evaluate and identify opportunities to improve UM processes and workflows, including vendor related workflows
• Implement process changes to enhance efficiency, effectiveness, and quality of UM services.
• Utilize data and analytics to support process improvement initiatives.
• Documentation and Reporting:
• Maintain accurate and up-to-date documentation of UM processes, procedures, and workflows.
• Develop and generate reports on UM performance metrics and operational activities.

To be successful in this role, you'll need:

• A Bachelor's degree in healthcare administration, business administration, or a related field.
• A minimum of 5+ years of experience in UM operations or a related healthcare operations role.
• Strong understanding of UM principles, processes, and regulations.
• Excellent analytical, problem-solving, and organizational skills.
• Strong written and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience with healthcare information systems and UM software is a plus.

Pay Transparency Statement:

This is a hybrid position based out of one of our offices: Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office three days per week (Plano, TX) or two days per week (Lehi, UT). #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.