Remote Optum Utilization Review Jobs in Colorado

Alma, a Spring Health Company, is on a mission to simplify access to high-quality, affordable mental health care. We do this by making it easy and financially rewarding for therapists to accept insurance and offer in-network care. When a provider joins Alma, they gain access to a suite of tools that not only help them better run their business, but also grow it sustainably and develop as a provider. Alma is available in all 50 states, with over 20,000 therapists in our growing network. Anyone looking for a therapist can browse Alma's free directory. Alma has raised $220.5M in funding from Insight Partners, Optum Ventures, Tusk Venture Partners, Primary Venture Partners, First Round Capital, Sound Ventures, BoxGroup, Cigna Ventures, and Rainfall Ventures. Alma was also named one of Inc's Best Workplaces in 2022 and 2023.

Candidate Interview Guide

Alma is looking for a Program Manager to join our Payer Success team within Operations. In this role, you'll be the central quarterback for our payer partnerships in steady-state operations – the person who holds the full picture across the end-to-end RCM lifecycle, from credentialing and rostering to claims adjudication to CX. You won't be expected to solve every issue yourself, but you will be the one making sure nothing falls through the cracks: tracking open issues, mobilizing the right internal experts, and driving accountability across teams until problems are resolved. You'll work closely across all teams at Alma, in particular within Operations and Business Development, to turn operational insights into action and improve outcomes across our payer portfolio. This is a full time, fully remote position on our team. Occasional travel may be required for team or company events/meetings.

What you'll do

• Track open payer issues end-to-end, ensuring clear ownership, visibility, and accountability across cross-functional teams until resolution
• Drive measurable business outcomes by improving RCM efficiency and effectiveness, with the ultimate goal of increasing revenue performance and delivering a better experience for Alma providers and their clients
• Partner closely with internal operations teams to connect the dots across stakeholders, subteams, and workflows - surfacing interdependencies and ensuring issues move to resolution rather than stall
• Serve as the primary operational point of contact for BD counterparts, triaging and coordinating new requirements surfaced by the payer and claims, roster, complaints, and escalation issues across assigned payers
• Partner with the Business Development Team on payer calls to drive RCM discussions, align stakeholders, and move issues to resolution
• Proactively monitor for new payer requirements and evolving payer mergers, and mobilize the right internal teams to implement changes before they become problems
• Track and report on RCM performance by payer - surfacing trends, flagging risks, and ensuring the right teams are engaged to drive improvement

What success looks like:

• Portfolio RCM performance improvement (e.g., denial rate, reimbursement, AR days)
• Portfolio payers meeting performance goals
• On-time completion of payer initiatives/projects
• Completion and maintenance of payer health assessments/business reviews
• Stakeholder satisfaction (internal and payer partners)

Who you are

• Experienced in healthcare operations - you understand how insurance claims and payer relationships actually work
• A strong cross-functional collaborator who can align people across teams without direct authority
• Highly organized with a track record of managing complex, multi-stakeholder projects from kickoff through launch
• Comfortable in ambiguity - you can proactively identify what needs to happen next without waiting to be told
• A clear communicator who can distill operational complexity for both internal partners and external payer contacts
• Detail-oriented and data-driven, with the ability to monitor performance metrics and translate them into action

Benefits:

• We're a remote-first company
• Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans
• 401K plan (ADP)
• Lifestyle Spending Account for health, wellness, and family care
• Monthly co-working space membership stipend
• Monthly work-from-home stipend
• Financial wellness benefits through Northstar
• Pet discount program through United Pet Care
• Financial perks and rewards through PerkSpot
• EAP access through Aetna
• One-time home office stipend to set up your home office
• Inclusive family and medical leave plans
• 12 paid holidays and 1 Alma Give Back Day
• Flexible PTO

The target base salary range for this position is $97,000 - $113,500. All Alma jobs are listed on our careers page. We do not use outside applications or automated text messaging in our recruiting process. We will not ask for any sensitive financial or identification information throughout the recruiting process. Any communication during the recruitment process, including interview requests or job offers, will come directly from a recruiting team member with a helloalma.com email address.