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Utilization Review Team Leader

2 months ago

Kansas City, Missouri, United States Elevance Health Full time

Job Description

Manager of Utilization Review

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

The Manager of Utilization Review is tasked with overseeing a team of healthcare professionals dedicated to optimizing member services, managing utilization, ensuring access, and conducting care management or concurrent reviews. This role is crucial in promoting cost-effective healthcare solutions for diverse member populations with varying medical needs, ensuring comprehensive service delivery that meets the holistic healthcare requirements of members.

Key Responsibilities:

Directs and supervises a team focused on identifying and managing cases involving multiple health conditions. Coordinates the delivery of services, including thorough assessments of physical health factors. Collaborates with healthcare providers to set achievable short- and long-term objectives that align with members' needs and capabilities. Identifies members at risk for significant health complications. Analyzes benefit systems and conducts cost-benefit evaluations. Reviews medical cases to ensure cost containment strategies are effective. Promotes compliance with programs and identifies areas for enhancing customer service and quality outcomes. Supports quality improvement initiatives, ensuring adherence to relevant standards and reporting requirements. Responsible for hiring, training, mentoring, and assessing the performance of team members.

Minimum Qualifications:

A Bachelor's degree and a minimum of 5 years of experience in healthcare management, or a combination of education and experience that provides equivalent expertise. A current, unrestricted professional license (such as RN, PA, LSW, LCSW, LPC, LMHC) as required by state laws and regulations.

Job Level:

Manager

Workshift:

Job Family:

MED > Licensed/Certified - Other

About Elevance Health:

Elevance Health is committed to enhancing lives and communities while simplifying healthcare. As a leading organization in the healthcare sector, we seek passionate leaders at all levels who aim to make a significant impact on our members and the communities we serve.

Our Work Culture:

At Elevance Health, we foster a culture that promotes strategic advancement and personal growth for our associates. Our core values and behaviors are integral to our culture, driving our strategy and business outcomes while ensuring shared success for our consumers, associates, communities, and business.

We provide a competitive total rewards package, including merit increases, paid holidays, Paid Time Off, and incentive bonuses, along with comprehensive benefits such as medical, dental, vision, disability coverage, 401(k) matching, stock purchase options, life insurance, wellness programs, and financial education resources.

Elevance Health operates under a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once a week unless otherwise specified. Specific onsite requirements will be discussed during the hiring process. Candidates must reside within the specified commuting distance of an Elevance Health location.

The health and safety of our associates and communities are paramount at Elevance Health. We require candidates in certain roles to be vaccinated against COVID-19, with exceptions made only for valid reasons. Elevance Health adheres to all applicable federal, state, and local laws.

Elevance Health is an Equal Employment Opportunity employer, ensuring that all qualified applicants receive consideration for employment without discrimination based on various protected statuses. Applicants needing accommodation during the application process may request assistance.