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Utilization Review Team Leader

2 months ago

Kansas City, Missouri, United States Elevance Health Full time

Job Overview

Position: Manager of Utilization Review

Location: This role operates in a hybrid model, combining remote work with office presence. Candidates must reside within a specified commuting distance of an Elevance Health facility.

The Manager of Utilization Review plays a pivotal role in supervising a team of healthcare professionals focused on optimizing member services, utilization management, access to care, and concurrent reviews. This position ensures effective and economical healthcare delivery for diverse member populations with varying medical needs, addressing their comprehensive healthcare requirements.

Key Responsibilities:

Directs and manages a team engaged in identifying and coordinating cases with complex health conditions. Oversees service provision, including comprehensive assessments of physical health factors. Collaborates with healthcare providers to set achievable short- and long-term objectives tailored to members' needs and capabilities. Identifies members at risk for significant health complications. Analyzes benefit systems and conducts cost-benefit evaluations. Reviews medical data to ensure cost-effective care. Promotes program compliance and identifies opportunities for enhancing customer service and quality outcomes. Champions quality initiatives, ensuring adherence to industry standards and reporting requirements. Responsible for recruiting, training, mentoring, and assessing the performance of team members.

Required Qualifications:

A Bachelor's degree and a minimum of five years of experience in healthcare management, or an equivalent combination of education and experience. A current, unrestricted license as a Registered Nurse, Physician Assistant, Licensed Social Worker, Licensed Clinical Social Worker, Licensed Professional Counselor, or Licensed Mental Health Counselor, as per state regulations.

Job Level:

Manager

Workshift:

Job Family:

MED > Licensed/Certified - Other

About Elevance Health:

Elevance Health is committed to enhancing lives and communities by simplifying healthcare. As a leading organization in the healthcare sector, we seek individuals at all levels who are dedicated to making a meaningful impact on our members and the communities we serve.

Our Culture:

At Elevance Health, we foster a culture that supports our strategic goals while promoting personal and professional development for our associates. Our core values and behaviors are integral to our culture, driving our success and shared outcomes for consumers, associates, communities, and the business.

We provide a competitive total rewards package, including merit increases, paid holidays, Paid Time Off, and incentive bonuses, alongside comprehensive medical, dental, and vision benefits, retirement plans, and wellness programs.

Elevance Health embraces a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location regularly, with specific onsite expectations discussed during the hiring process. Candidates must reside within a reasonable commuting distance of an Elevance Health location.

The health and safety of our associates and communities are paramount. We require candidates in certain roles to be vaccinated against COVID-19, with accommodations considered as per applicable laws.

Elevance Health is an Equal Employment Opportunity employer, ensuring that all qualified applicants receive fair consideration for employment, free from discrimination based on various protected statuses.