Manager Utilization Management

Why Join Us?

• →

  Awareness and understanding of medical necessity, utilization patterns, standards of practice, and health care environment as they relate to all programs and staffing.

• →

  Demonstrated ability to communicate effectively across multiple channels while maintaining professionalism and confidentiality.

• →

   Effective time management, independent decision-making, and prioritization skills with flexibility to respond to changing priorities. Ability to obtain and analyze utilization, system, and workflow data.

• →

  Coordinates with procurement for vendor contracts.

• →

  Prepare and present information about medical necessity reviews to internal and external customers.

• →

  Interpersonal skills to effectively and professionally handle sensitive medical necessity, utilization, and cost issues with members, providers, group representatives, and other internal and external customers.

• →

  Familiarity with enterprise project management methodologies and collaborative planning practices (Agile, Scrum).

• Bachelor of Science in Nursing (BSN) or a bachelor’s degree in a health related or business field required.

• Registered Nurse with a minimum of five years of clinical experience required.

• Minimum 5 years of Utilization Management experience, preferably in a leadership or managed care setting required.

• Must have a current, active, and unrestricted Kansas RN License.

• 95% of daily activity requires use of PC

• Capable of complying with all Kansas laws and regulations regarding the operation and use of motor vehicles. Must have a valid driver’s license. Able to travel, including overnight.

Compensation

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.