Senior Manager, Utilization Management (UM) Operations

The Senior Manager, Utilization Management (UM) Operations provides strategic and operational leadership to ensure timely, accurate, and compliant processing of authorizations, referrals, and clinical review activities. This role oversees daily UM operations, ensures compliance with service level agreements (SLAs) and regulatory requirements, and partners cross‑functionally to support departmental and organizational goals while maintaining audit readiness across UM functions.

What You’ll Do

In this role, you will:

• Promote a positive, collaborative, and high‑engagement team culture rooted in trust, continuous learning, and service excellence
• Lead, coach, and mentor UM managers and staff to drive effective performance, consistency, and accountability across all UM functions
• Oversee recruiting, hiring, onboarding, training, and talent development of UM team members
• Define and communicate performance expectations, KPIs, productivity standards, and quality metrics; conduct performance reviews and staff meetings
• Address performance and behavioral issues promptly through coaching, feedback, and corrective action when necessary
• Maintain visibility into UM inventory and turnaround times and ensure compliance with SLAs at corporate, client, and regulatory levels (CMS, NCQA, URAC)
• Ensure departmental adherence to UM processing guidelines, workflows, and policies across teams
• Review UM trends, operational data, and case files to identify improvement opportunities and implement best practices
• Lead or support automation initiatives, system enhancements, and process redesign to reduce manual work and increase accuracy
• Ensure audit readiness and lead responses to internal and external audits, including corrective action plans
• Serve as an operational lead and UM subject‑matter expert in cross‑departmental initiatives, issue resolution, process improvements, new implementations, and client onboarding
• Partner with analytics and reporting teams to enhance dashboards, scorecards, forecasting models, and operational reporting tools; provide leadership with actionable insights
• Lead or support enterprise initiatives such as cost‑containment programs, product expansions, RFP support, operational readiness for new markets, and strategic transformation efforts
• Manage special projects as assigned, ensuring clear deliverables, timelines, and communication plans
• Perform other duties as assigned while maintaining professionalism, sound judgment, and adaptability

What You Bring

Education & Experience

• Bachelor’s degree in Healthcare Administration, Business, or a related field (or equivalent combination of education and experience)
• Minimum 8 years of Utilization Management or healthcare operations experience (dental plan experience preferred)
• 3–5 years of leadership experience managing UM teams, clinical operations, or high‑volume administrative operations

Skills & Knowledge

• Proven leadership, staff development, and team‑building abilities
• Extensive knowledge of UM processes, preauthorization/referral workflows, and related systems
• Excellent organizational, analytical, and writing skills
• Strong presentation skills with the ability to communicate effectively with executive audiences
• Proficiency with Microsoft Office tools (Word, Teams, Outlook, PowerPoint)
• Strong conflict management skills
• Ability to work independently while driving strategic direction

Why This Role

This is a highly visible leadership role with direct impact on operational performance, regulatory compliance, and service excellence. The Senior Manager, UM Operations plays a critical role in shaping how utilization management supports members, providers, and the organization.