Manager, Utilization Management- Hybrid

The Utilization Management (UM) team at UVM Health is searching for a UM Manager to join their leadership team!

Please note: This position is hybrid, allowing for remote and requiring an onsite presence at UVM Health Care Partners quarterly.

JOB SUMMARY

The Manager of Utilization Management leads teams responsible for oversight of staff and daily operations within the Utilization Management (UM) department. This role provides training, guidance, and support to direct reports, ensures regulatory compliance, and contributes to UM programming across the UVM Health. The manager ensures quality outcomes in medical necessity review, appeals, denials, and patient status determination.

CORE COMPETENCIES

Leadership & Team Development

- Coaches and mentors team members to enhance performance.

- Promotes a positive work environment that supports staff engagement.

- Leads change initiatives with confidence and clarity.

- Encourages professional development and continuous learning.

Communication

- Communicates complex clinical requirements clearly to staff and stakeholders.

- Actively listens and responds with empathy and professionalism.

- Adjusts communication style based on audience needs.

- Delivers constructive feedback in a respectful and timely manner.

Regulatory Knowledge

- Applies Medicare, Medicaid, and CMS regulations accurately.

- Ensures compliance with JCAHO and HIPAA requirements.

- Maintains up-to-date knowledge of UM policies and guidelines.

- Educates staff on regulatory updates and expectations.

Critical Thinking & Decision Making

- Evaluates clinical data to determine appropriate patient status.

- Makes sound decisions in complex utilization review cases.

- Identifies issues and develops solutions proactively.

- Analyzes trends to inform process improvement efforts.

Collaboration & Relationship Building

- Builds effective relationships with care management and clinical teams.

- Partners with internal and external stakeholders to optimize UM operations.

- Facilitates cross-functional communication and teamwork.

- Demonstrates respect and cultural competence in all interactions.

Accountability & Results Orientation

- Takes ownership of departmental goals and outcomes.

- Ensures timely completion of tasks and adherence to timelines.

- Monitors performance indicators and implements corrective strategies as needed.

- Demonstrates reliability and consistent follow-through.

EDUCATION

Education: Bachelor’s Degree in Nursing required. Master’s degree in nursing or experience equivalent preferred.

Licensure: Current and Active Registered Nurse (RN) license.

CM certification preferred Case management accreditation required by a nationally recognized accrediting body for case management (examples: CCM, ACM or ANCC certifications), preferred.

EXPERIENCE

Experience working within a unionized environment preferred.

3-5 years of leadership experience in a healthcare setting required

3-5 years of clinical experience in a healthcare setting (or equivalent) required

Care Management/Care Coordination experience required

WHY UVM Health (UVMH)?  

UVM Health is dedicated to our patients, providing the highest quality care for patients and their families. It is a mission that defines our culture, one of teamwork and collaboration. Every employee, whether they work directly in patient care or in a supporting role, has a hand in contributing to the wellness of the patient and the community.
  

BENEFITS
At UVM Health, we support our employees as passionately as we care for our patients. We offer a comprehensive, total compensation package that includes salary, health and wellness benefits, paid time off, and more.  

• https://www.uvmhealth.org/medcenter/health-careers/benefits   

LEARN MORE  

• What is it like working here? https://www.uvmhealthnetworkcareers.org/diversity-equity-inclusion.html  

• Find more information about the University of Vermont Health Network here: https://www.uvmhealth.org/about-uvm-health-network