Utilization Management Market Operations Manager - RN Preferred - Must live in Nevada - Must hold NV license
Salary$83k – $133k
LocationRemote
Work moderemote · United States
Typefull-time
SenioritySenior
Experience5+ yrs
DepartmentUtilization Management (UM)
Company size1,001–5,000 people
First seenOct 3, 2026 · 1w ago
Verified live1d ago
At a glanceSummarised by Seekless from the posting.
Must have20
Associate's degree in Nursing or master's degree in Psychology
Minimum of five (5) years of experience in UM or related operations
Managed Care experience
Experience with analysis, data and reporting
Demonstrated change management and continuous improvement leadership skills
Proficient use of Microsoft Office Suite
Fluent in NCQA and/or CMS, accreditation and audit standards
Decision making/problem solving and critical thinking skills
Planning, problem identification and resolution skills
Strong oral, written and interpersonal communication skills
Responsive to a changing environment/change resiliency
Proficiency with quality improvement, performance improvement and operations
Ability to develop, prioritize and accomplish multiple competing goals
Strong collaboration skills with ability to work with multi-disciplinary departments
Ability to work independently and within a team
Strong attention to detail and time management skills
Customer service oriented with de-escalation skills
Ability to gather/analyze data and create meaningful action items
Ability to review and implement evidence-based trends
Current, unrestricted Registered Nurse (RN) licensure or Licensed Psychologist in state of practice
Nice to have3
Accreditation, auditing, and process improvement experience
Previous experience with quality control and/or process standards
Six Sigma or project management certifications
Skills
Microsoft Office Suite
Word
Excel
PowerPoint
Outlook
Visio
Job Summary:
The Utilization Management (UM) Market Operations Manager is responsible for the operational activities of UM and Appeals for a specified line(s) of business managing the development of policies and procedures, review of team metrics, statutory reporting, overseeing committee reviews, audit preparation and presentations, and preparation and presentation of annual program requirements.
Essential Functions:
•
Utilize process controls to achieve operational excellence in all areas within the department
•
Actively work with clinical leadership in closing variances of operational procedures
•
Oversee and support the development and maintenance of staff resources including but not limited to policies and standard operating procedures that ensure departmental alignment and adherence to contractual, state, NCQA, federal and other applicable guidelines
•
Drive process improvement by utilizing continuous improvement frameworks
•
Manage policy and process changes that result from regulatory/compliance requirements
•
Educate, mentor, and train staff and clinical leaders on requirements, process improvement and quality
•
Manage various relationships with both internal and external partners to improve standardization and interdepartmental collaboration on enterprise goals and initiatives
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Work collaboratively with appropriate departments to define and utilize outcome measurements in defining and driving success
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Design future state operation models that address opportunities
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Manage cross-divisional and cross-functional process improvement opportunities such as new business, systems and delegations
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Oversee and support change management initiatives that impact the department
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Perform any other job duties as requested
Education and Experience:
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Associates degree in Nursing or advances degree is Psychology is required
•
A minimum of five (5) years of experience in UM or related operations related to the responsibilities of this position is required
•
Managed Care experience is required
•
Experience with analysis, data and reporting is required
•
Accreditation, auditing, and process improvement experience is preferred
•
Demonstrated change management and continuous improvement leadership skills required
•
Previous experience with quality control and/or process standards preferred
Competencies, Knowledge and Skills:
•
Proficient use of Microsoft Office Suite, to include Word, Excel, PowerPoint, Outlook, and Visio knowledge with a strong willingness to learn
•
Fluent in NCQA and/or CMS, accreditation and audit standards with knowledge of regulatory reporting, compliance requirements, and auditing procedures
•
Decision making/problem solving and critical thinking skills
•
Planning, problem identification and resolution skills
•
Strong oral, written and interpersonal communication skills
•
Responsive to a changing environment/change resiliency
•
Proficiency with quality improvement, performance improvement and operations
•
Ability to develop, prioritize and accomplish multiple competing goals
•
Strong collaboration skills with ability to work with multi-disciplinary departments
•
Ability to work independently and within a team
•
Strong attention to detail and time management skills
•
Customer service oriented with de-escalation skills
•
Ability to gather/analyze data and create meaningful action items
•
Ability to review and implement evidence-based trends
Licensure and Certification:
•
Current, unrestricted Registered Nurse (RN) licensure or Licensed Psychologist in state of practice is required
•
Six Sigma or project management certifications are a plus
Working Conditions:
•
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Fostering a Collaborative Workplace Culture
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.