Utilization Management Manager

About Astiva Health, Inc.: We are a leading healthcare provider specializing in Medicare and HMO services. Our commitment is to deliver comprehensive care tailored to the diverse needs of our community, focusing on accessibility, affordability, and quality. Join our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. Position Overview: Astiva Health Inc is seeking a dynamic and collaborative Utilization Management Manager to join our team. Reporting to the UM Director, you will play a key role in cultivating excellence in service for our members. Your primary goal will be to establish and nurture high-quality Utilization Management operations that meet and exceed service level agreements (SLAs) and key performance indicators (KPIs). Key Responsibilities: Conduct ad hoc UM audits and delegate oversight audits to ensure compliance and quality. Analyze data and prepare clear, accurate reports following UM policies, identifying opportunities for improvement through trend analysis. Ensure that all SLAs are consistently met and reported on a monthly basis. Lead orientation and training programs for new Utilization Management staff, focusing on role expectations and workflows. Perform case reviews of Utilization Management Coordinators to assess adherence to policies, teamwork, and utilization trends. Provide constructive feedback on productivity and management of case loads. Maintain confidentiality and adhere to company policies regarding privacy. Oversee and mentor the Utilization Management team, ensuring frequent communication and support. Promote team development in a professional environment where all staff can excel. Engage in regular collaboration and communication with providers, clinical staff, case managers, and clients to facilitate collective decision-making where necessary. Manage daily interactions and participate in quarterly meetings with client organizations to ensure high-quality UM operations. Exhibit consistent attendance and perform other duties as assigned. Qualifications: Active and unrestricted US Registered Nurse license is required. An Associate's or Bachelor's Degree is required. Minimum 3 years of clinical nursing experience. At least 2 years of experience in Utilization Management or Case Management. 2 years of supervisory, management, or team lead experience is essential. Demonstrated problem-solving abilities, facilitation, and analytical skills. Proficient in Microsoft Excel, PowerPoint, Outlook, and Teams. Ability to work independently as well as in a collaborative team environment. Benefits: We offer a comprehensive benefits package, including 401(k), Dental Insurance, Health Insurance, Life Insurance, Vision Insurance, Paid Time Off, and free catered lunches.

Created: 2026-03-11