Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
May 22, 2026
Full Job Description
đź“‹ Description
- • The Manager, Utilization Management (UM) Strategy & Implementation leads a dedicated team supporting the UM program through regulatory and compliance functions, including prior authorization analysis, new business implementation, policy development, internal risk analysis, and audit preparation, ensuring consistency with CareSource goals and objectives.
- • Day-to-day responsibilities include establishing compliance baselines, overseeing CAP management and audit activities, building cross-functional relationships, developing policy documentation, identifying process gaps, managing process changes, maintaining knowledge of regulatory environments, developing implementation plans for new business and product filings, hiring and developing direct reports, supporting accreditation initiatives, representing UM in regulatory inquiries, monitoring compliance measures, collaborating with data and clinical teams on reporting, serving as liaison between Clinical Operations and senior leadership, reviewing departmental policies, reporting audit readiness, and collaborating on predictive measurements.
- • The team operates within CareSource Management Group Company, a mission-driven healthcare organization focused on improving health outcomes and reducing disparities through innovative, compliant, and efficient utilization management strategies across multiple lines of business and markets.
- • In this role, the individual will develop strategic leadership in healthcare compliance and accreditation, gain expertise in regulatory reporting and process improvement, strengthen cross-functional influence, and build experience in managing UM operations at scale, positioning them for advancement in healthcare operations, compliance, or leadership roles.
🎯 Requirements
- • Bachelor’s Degree in nursing or related field
- • Minimum of five (5) years clinical or related healthcare industry experience
- • Prior leadership experience is required
- • Managed Care experience is required
- • Experience with analysis, data and reporting is required
- • Current, unrestricted Registered Nurse (RN) licensure is preferred
🏖️ Benefits
- • Base compensation range of $83,000.00 - $132,800.00
- • Eligibility for performance-based bonus tied to company and individual results
- • Comprehensive total rewards package supporting employee total well-being
- • Opportunity to work remotely
- • Support for professional development through training and coaching responsibilities
- • Exposure to accreditation processes including NCQA and URAC initiatives
Skills & Technologies
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About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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