Job Details

Job Description:
We are seeking an experienced utilization management leader to oversee operations and provide strategic direction for the utilization management department. This hybrid opportunity is based in Colorado and involves managing a team, while ensuring compliance with regulatory and contractual requirements across multiple lines of business.

Responsibilities:

• Provide leadership, management and oversight of the utilization management department, supervising approximately 15 team members.

• Ensure adherence to turnaround times and contractual compliance requirements for prior authorizations, medical necessity reviews and concurrent/retrospective reviews.

• Oversee coordination of peer-to-peer reviews and related utilization management processes.

• Guide continuous improvement initiatives related to information systems, productivity, and policy alignment with CMS and market standards.

• Support ongoing operational initiatives, including optimization of auto-authorization workflows, and vendor-supported peer-to-peer and automation processes.

Requirements:

• Active Colorado RN license

• 7+ years of utilization management experience within a health plan or healthcare provider setting

• Strong familiarity with MCG criteria and Guiding Care

• 4+ years of supervisory or management experience

• Proven collaborative leadership and team management skills

• Experience with QNXT (preferred)

• Cross-functional experience with claims, grievances/appeals and care management (preferred)

Pay Range:
The anticipated pay range for this position is $70.00 - $80.00 hourly.
We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity.
We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) retirement savings plan

Contact:
Karrie Ruch
+1 (312) 884-0418
kruch@jacobsongroup.com

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsononline.com or +1 (800) 466-1578 to make a request.