Manager, Utilization Management

Taking Care of Our Nation’s Heroes. It’s Who We Are. It’s What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®! Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Manages prospective and concurrent Utilization Management (UM) programs including prior authorization, concurrent inpatient and continued stay reviews including authorization and management of selected post inpatient care. This position reports to the Director of UM and coordinates with Case Management (CM) and Care Coordination (CC) Managers. The position is responsible for providing assistance with the development of UM desk procedures, training, auditing and implementing UM program policies consistent with contractual and performance management goals.

Provides leadership to ensure operational effectiveness and efficiency of prospective and concurrent UM including discharge planning activities to meet and exceed production and service-level goals. Provides coaching and oversight to staff to ensure staff success and development. Oversees the program quality assurance and quality improvement processes related to UM programs. Generates reports to identify trends and opportunities for process improvement. Facilitates efforts to enhance UM programs by working collaboratively with the UM Director and other Medical Management leaders to effectively manage contract and internal performance standards. Provides assistance with Desk Procedures (DP) development monitors and provides assistance with application use and training programs in support of DPs. Collaborates with Data Management staff for data compilation and statistical analysis regarding program outcomes. Develops audit reports to identify quality issues and to identify areas for enhanced staff training. Develops new training programs, training documents, and flow diagrams to address targeted operational issues. Collaborates with clinical leadership to implement new processes for enhancing service levels. Assists the UM Director with staffing projections for contract management and budgets. Performs other duties as assigned. Regular and reliable attendance is required.