Utilization Management Manager (Medicare and Medicaid)

Location: Remote in Wisconsin or a bordering state; occasional travel to hirify.global offices may be required. Working hours are Monday–Friday, 8:00am–5:00pm Central Standard Time.

Salary: $94,900–$130,500 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and health insurance company serving members through Medicare, Medicaid, insurance, and healthcare services.

What you will do

• Lead nurses and support staff responsible for utilization management and prior authorization operations.
• Oversee medical necessity and level-of-care reviews for inpatient, outpatient, and behavioral health services.
• Ensure authorization decisions are accurate, compliant with regulations, and aligned with internal policies.
• Monitor productivity, quality, service levels, operational metrics, and departmental workflows.
• Guide complex clinical and operational escalations and educate providers on utilization management requirements.
• Lead process improvement, trend analysis, coaching, and cross-functional initiatives.

Requirements

• Bachelor’s degree.
• Active, unrestricted Registered Nurse license in Wisconsin or a compact state.
• At least 3 years of utilization management experience.
• At least 2 years of experience managing clinical or operational teams.
• Ability to work remotely from Wisconsin or a bordering state and maintain Central Standard Time working hours.
• Dedicated workspace and home internet with at least 25 Mbps download and 10 Mbps upload speeds to protect member PHI and HIPAA information.

Nice to have

• Experience adjudicating or leading teams handling inpatient, outpatient, and behavioral health authorizations.
• Experience with Medicare and Medicaid utilization review.
• Experience leading process improvement or operational efficiency initiatives in managed care.
• Experience writing complex Excel macros.

Culture & Benefits

• Full-time, 40-hour workweek with a remote-home workstyle.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability coverage, life insurance, and wellness-focused benefits.