Manager Utilization Management Jobs in Hartford, WI

Manager, Referral Coordination

Little Rock, Charlotte, Milwaukee, Cleveland, Philadelphia and St. Louis Markets

Job Summary:

The Manager, Referral Coordination leads the referral coordination function, ensuring members receive high-quality, timely, and cost-effective care. This role provides leadership, coaching, and operational oversight for a team of Referral Coordinators, while driving consistency in referral management practices, optimizing referral network utilization, and supporting the implementation of standardized referral coordination processes across the organization.

Partnering closely with Market Leaders in Operations and Clinical, the Manager, Referral Coordination monitors referral utilization trends, identifies opportunities for improvement, and leads initiatives that enhance quality, efficiency, and performance outcomes. The ideal candidate is a people-focused leader with expertise in care coordination, referral management, and value-based care, as well as strong analytical, project management, and change leadership skills.

Duties and Responsibilities

• Lead, coach, and develop a team of Referral Coordinators, fostering a culture of accountability, collaboration, and member-centered service.
• Manage colleague performance through hiring, onboarding, goal setting, coaching, development planning, and performance evaluations.
• Monitor team performance metrics and drive engagement, retention, and career growth opportunities.
• Lead the development, implementation, and ongoing optimization of standardized referral coordination processes, tools, and best practices across the enterprise.
• Oversee referral utilization, specialty network performance, and care coordination outcomes, leveraging data and analytics to identify trends, improvement opportunities, and cost-effective care strategies.
• Provide reporting, insights, and recommendations to market and enterprise leaders to drive referral management performance and informed decision-making.
• Ensure effective adoption, compliance, and optimization of referral management systems, workflows, and utilization management processes.
• Partner with Market Leadership, Operations, Clinical Leadership, Population Health, and external vendors to resolve referral management challenges, improve network utilization, and support enterprise initiatives.
• Serve as the primary liaison for referral management vendors and partners, including oversight of specialist tiering, referral optimization, and network performance strategies.
• Lead process improvement initiatives, system enhancements, and change management efforts that improve member access, care quality, operational efficiency, and provider alignment.
• Communicate organizational priorities, performance outcomes, and referral management strategies while fostering collaboration and consistency across markets.

Required Skills and Abilities

• Demonstrated experience leading, coaching, and developing high-performing teams.
• Strong understanding of referral management, care coordination, and healthcare operations.
• Ability to influence and drive accountability across multiple stakeholders and departments.
• Strong project leadership and change management capabilities.
• Excellent analytical and problem-solving skills with the ability to translate data into operational improvements.
• Ability to establish priorities and lead multiple initiatives in a fast-paced environment.
• Excellent verbal, written, and presentation communication skills.
• Strong interpersonal and relationship-building skills.
• Proficiency in performance management and colleague development.
• Ability to effectively manage ambiguity and drive results.

Qualifications

• Associate's or Bachelor's degree in Healthcare Administration, Nursing, Healthcare Information Systems, Business Administration, or a related field preferred.
• Minimum of 7 years of experience in care coordination, case management, utilization management, population health, healthcare analytics, or quality improvement required; leadership or supervisory experience preferred.
• Demonstrated knowledge of care coordination processes, referral management workflows, utilization trends, care transitions, and healthcare operations.
• Experience analyzing healthcare data and translating insights into operational improvements and business recommendations.
• Knowledge of value-based care models, population health strategies, and specialty network management preferred.
• Proven ability to lead cross-functional initiatives, manage competing priorities, and drive results in a dynamic healthcare environment.
• Strong analytical, communication, problem-solving, and stakeholder management skills.
• Proficiency with healthcare technology platforms, reporting tools, and Microsoft Office applications.
• Ability and willingness to travel up to 20% as business needs require.
• Demonstrates and models ArchWell Health's core values: Be Compassionate, Strive for Excellence, Earn Trust, Show Respect, Stay Resilient, and Always Do the Right Thing.

About ArchWell Health:

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood