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Remote Supervisor Utilization Management Jobs in Maryland

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote JobDuration: Contract / FTE Client: Federal Criteria-Need US citizenshipbecause of federal ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

Bcbsa

Director, Trade Client Relations

California, MD · On-site +1

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

Director, Trade Client Relations

Baltimore, MD · On-site +1

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

Director, Trade Client Relations

Gaithersburg, MD · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Alpine Physician Partners

Director, Affordability Alpine Physician Partners | Remote-Flexible The Role This role is ... Design and manage programs to reduce avoidable admissions, readmissions and ED utilization in ...

Revel Staffing

IT Support Supervisor

Baltimore, MD · Remote

$80K - $115K/hr

We are seeking an experienced IT Support Supervisor to lead a remote team focused on IT training, ... Experience leading teams, managing priorities, and supporting remote employees * Strong ...

Harris

... utilization) to increase output and reduce rework. * Lead change management and adoption for new ... supervisor/team lead/manager level). * Demonstrated success improving KPI outcomes (A/R aging ...

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Remote Supervisor Utilization Management information

What is the difference between Remote Supervisor Utilization Management vs Remote Utilization Review Nurse?

AspectRemote Supervisor Utilization ManagementRemote Utilization Review Nurse
CredentialsRN, often with management or supervisor certificationsRN, with clinical review certifications
Work EnvironmentSupervises teams, manages utilization processes remotelyPerforms clinical reviews, assesses patient necessity remotely
Employer & Industry UsageHealth insurance companies, managed care organizationsInsurance companies, third-party administrators
Primary FocusOverseeing utilization management operationsConducting clinical utilization reviews

Remote Supervisor Utilization Management roles focus on overseeing utilization management teams and processes, ensuring compliance and efficiency. In contrast, Remote Utilization Review Nurses primarily perform clinical assessments to determine the necessity of services. Both roles require RN credentials but differ in responsibilities and scope within the utilization management field.

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Remote Supervisor Utilization Management jobs near you

Senior Director, Complex Care Management and Utilization Management - 2947

AbsoluteCare

Baltimore, MD • On-site, Remote

Full-time

Re-posted 22 days ago

Job description

  • This role will involve up to 40% Travel across AbsoluteCare locations
  • RN license preferred.
  • Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus.

Job Summary
This Senior Director role over Complex Care Management (CCM) and Utilization Management (UM) is a strategic senior leader position that is responsible for designing, implementing, and optimizing integrated care delivery models that improve health outcomes for medically and socially complex populations. This role oversees the national CCM and UM programs, ensuring alignment with at-risk value-based care principles, transitional care management, regulatory compliance, and operational excellence across all markets. Experience with delegated care management and/or utilization management from a health plan is a major plus.
Duties and Responsibilities
Program Oversight
  • Direct the implementation of high-intensity, member-centered care models that reduce avoidable utilization and improve quality of life.
  • Leads conversations with medical economics on understanding the financial impacts of both care management and utilization management programs.
  • Supports the build of useful daily management reports to help support local managers in managing their team's productivity and effectiveness.
  • Develops materials and leads a monthly overview meeting for key executives to talk about strategic direction of both CCM and UM programs and executes on the strategy.
    - Ensure compliance with NCQA standards and other regulatory requirements for UM and care coordination services.
  • Supervises, leads a CM Program Manager, TCM program lead , two Clinical Educators, and three centralized Community Team Care Managers (total of 4-7 direct reports).
Operational Excellence
  • Monitor and optimize care and utilization management workflows, staffing models, and performance metrics across CM and UM teams including bed management, admissions, and ED utilization.
    - Lead the development of efficient and effective clinical training programs, documentation standards, policies and procedures and performance management systems to support clinical and non-clinical staff.
Team Development
  • Build and mentor a high-performing interdisciplinary team including care managers, behavioral health clinicians, UM nurses, and community health workers.
    - Foster a culture of accountability, innovation, and continuous improvement.
  • Responsible for working with site leaders to develop and implement clinical engagement/retention action plans that enhance staff satisfaction survey results
Stakeholder Engagement
  • Serve as a key liaison with payer and health system hospital partners, regulatory bodies, and internal stakeholders to ensure transparency, compliance, and shared success.
  • -Develop strong working relationships with market UM/CM leaders, engagement leaders and VPs that influence optimal clinical engagement AND clinical model execution.
    - Represent the organization in strategic discussions with external partners and at industry forums.

Minimum Qualifications
  • Bachelor's degree in Nursing, Public Health, Health Administration, or related field required; Master's degree preferred.
    - Minimum of 7-10 years in a Senior Director or Vice President role overseeing complex care management, transitional care management or utilization management in a managed care or at-risk value-based medical group environment.
    - Proven track record of leading large-scale, multi-site clinical operations, driving cost savings, achieving affordability targets and improving patient outcomes.
    - Deep understanding of Medicaid/Medicare populations, transitional care management leading to readmission reduction, , and integrated care delivery models.
    - Strong leadership, communication, and change-management skills.
  • Knowledge and experience working with ZeOmega/Jiva electronic health record is a plus, but not required.
  • Must be willing to travel across our different markets to interact with corporate leadership team, managers, and front-line staff.
Preferred Certifications
  • RN license preferred.
  • Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus.

Working conditions
This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.
Physical requirements
  • Ability to communicate clearly and exchange accurate information constantly.
  • Ability to remain stationary for long periods of time.
  • Repetitious movements.
  • Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment

Direct reports
Care Management Program (lead) Manager, Transitional Care Manager Program (Lead) Manager, Centralized CCM, Clinical Educator
Company Description:
Why Work at AbsoluteCare?
At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.
We call this "care beyond medicine." We have turned the doctor's office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members' needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.
We don't stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.
Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.
AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

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