[Hiring] Utilization Management Manager @Yamhill Community Care

Role Description

This position is responsible for the successful oversight and management of the Utilization Management (UM) team and associated activities and deliverables. Working collaboratively across Yamhill Community Care (YCCO) teams as well as with external partners and the community. This position will manage the day-to-day operations and direct supervision of UM staff. This UM Manager monitors the effectiveness / outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed. The UM Manager will manage a team that supports the triple aim and positive outcomes for YCCO members.

Qualifications

• Bachelor’s degree in Nursing or other Healthcare related field, such as Behavioral Health, Healthcare Administration.
• Three (3+) years of experience supervising or leading teams.
• Two (2+) years of Utilization Management experience.
• Master’s degree in Nursing or other Healthcare related field (preferred).
• Five (5) years of relevant clinical nursing or healthcare related experience (preferred).
• Experienced in physical and behavioral health integration (preferred).
• Experience with Coordinated Care Organization (CCO) / Medicaid Managed Care (preferred).
• Three (3+) years of experience with Utilization Management (preferred).

Requirements

• ACM (Accredited Case Manager) through AMCA (American Case Management Association) (preferred).
• CCM (Certified Case Manager) through CCMC (Commission for Case Manager Certification) (preferred).
• Board certification in Nursing Case Management (RN-BC) through ANCC (American Nurses Credentialing Center) (preferred).
• CPHQ (Certified Professional in Health Care Quality) through NAHQ (National Association of Health Care Quality) (preferred).

Benefits

• 100% remote work option available.
• Support for professional development and training.
• Opportunity to work in a collaborative and supportive environment.

Company Description

Yamhill Community Care is a nonprofit coordinated care organization dedicated to managing the healthcare for Medicaid members, covered under the Oregon Health Plan, in Yamhill County, as well as parts of Washington and Polk Counties. Our mission is to improve the quality of life of the communities we serve by coordinating effective care. Beyond healthcare, we also provide an Early Learning Hub, supporting families and children with essential resources and programs for early childhood development. Together, we're building a unified healthy community that celebrates physical, mental, emotional, spiritual, and social well-being.