Our mission is Better Health. Our passion is helping others.

What’s Your Why?

• Are you looking for a career opportunity that will help you grow personally and professionally?
• Do you have a passion for helping others achieve Better Health?
• Are you ready to join a growing team that shares your mission?

Why Join Our Team: At Better Health Group, it’s our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don’t just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

Position Objective:

The Manager, Utilization Management Manager oversees and monitors the organization’s Utilization Management functions. The goal is to achieve clinical, financial, and utilization goals by focusing on clinical case reviews and audits, clinical program improvements, and quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness.  The Manager, Utilization Management Manager actively manages a clinical team while also directly reviewing and processing Utilization Management cases as needed.  The position will report to the Vice President, Health Services Operations.

Responsibilities:

• Perform routine audits and clinical case reviews for high-cost cases and other programs; summarize findings for internal meetings and discussions with health plan partners and providers.
• Facilitate and collaborate in high-cost case review and other clinical program meetings with the Chief Medical Officer and key stakeholders.
• Lead and mentor a clinical team by providing ongoing supervision, clinical guidance, and support to ensure the efficient and effective delivery of services.
• Conduct regular quality audits and performance assessments of team members; coach staff to enhance skills, improve performance, and achieve optimal outcomes.
• Conduct employee performance reviews and maintain appropriate documentation
• Work with leadership to develop, implement, and actively facilitate staff training, development initiatives, and team meetings.
• Participate in the development and implementation of departmental playbooks and workflows; monitor compliance and recommend revisions to optimize resource utilization.
• Track, monitor, and communicate trends in Key Performance Indicators (KPIs); analyze data to identify opportunities, drivers, and barriers to high-quality care.
• Utilize data to report productivity and outcome measures; collaborate with management to implement improvement strategies.
• Collaborate with cross-functional teams to address operational challenges, resolve issues, and coordinate activities.
• Escalate unresolved or complex issues to the Vice President, Health Services as appropriate.
• Conduct regular meetings with internal and external stakeholders (e.g., payers, hospitals, SNFs, providers) to review program initiatives and progress.
• Stay current with industry regulations, guidelines, and best practices to ensure compliance and drive continuous improvement.
• Assist with the preparation of departmental dashboards and reporting.
• Other duties as assigned.

Position Requirements/ Skills:

• Bachelor's Degree in Nursing required.
• Proof of successful completion of educational requirements for a Registered Nurse as defined by the state of Florida, along with current, active licensure in good standing.
• Licensure must be obtained for additional states or territories, as required.
• 4+ years of Care Coordination experience.
• 2+ years of leadership or management experience.
• Complex Case Management (CCM) certification is a plus.
• Proven success collaborating with interdisciplinary and cross-functional teams.
• Proficient in Google Suite (Drive, Docs, Sheets, Slides) for real-time collaboration.
• Demonstrated ability to manage sensitive data with confidentiality.
• Strong organizational and time-management skills, with the ability to multitask and maintain attention to detail.
• Excellent written, verbal, and interpersonal communication skills, including comfort presenting to senior leadership, providers, and health plans.
• Strong critical thinking and problem-solving abilities.
• Results-oriented with a focus on quality execution and accountability.
• Appreciation for cultural diversity and sensitivity to the needs of target patient populations.

Physical Requirements:

• Ability to remain in a stationary position, often standing or sitting for prolonged periods of time.
• Communicating with others to exchange information.
• Repeating motions that may include the wrist, hands, and/or fingers.
• Assessing the accuracy, neatness, and thoroughness of work assigned.
• Must be able to lift at least 15 lbs at times.

Key Attributes/ Skills:

• Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles.
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments.
• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion.
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals.