Manager, Utilization Review

TL;DR

Manager, Utilization Review (Care Management): Supervising day-to-day operations of assigned Utilization Management staff, including scheduling, workload distribution, and adherence to established workflows with an accent on clinical rationale, documentation quality and timeliness. Focus on driving team performance against key metrics, including engagement, productivity, quality scores, and turnaround times.

Location: Remote, United States

Salary: $95,000 - $105,000

Company

hirify.global created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place.

What you will do

• Supervise day-to-day operations of assigned Utilization Management staff, including scheduling and workload distribution.
• Provide full people management for assigned Utilization Management teams, including hiring, performance management, and staff development.
• Monitor documentation for completeness, accuracy, timeliness, and compliance with company policies and regulatory requirements.
• Analyze operational and quality data to identify trends, gaps, and opportunities for improvement.
• Collaborate with cross-functional partners to resolve issues and improve care coordination.
• Lead complex initiatives involving process redesign, system optimization, and performance improvement.

Requirements

• Current, unrestricted RN license in the United States or U.S. territory (compact license acceptable where applicable).
• Graduate of an accredited nursing program (ADN or diploma required; BSN preferred).
• Knowledgeable of the Federal, State, DMHC, CMS and ERISA regulations.
• 1-2 years in care management, utilization management, discharge planning, or related clinical coordination.
• Basic computer literacy and proficiency in software applications including Microsoft Word, Microsoft Excel, and Outlook.
• Excellent verbal and written communication skills.

Culture & Benefits

• Competitive base salary and benefits effective day one.
• Comprehensive medical and dental through our own health solutions.
• Unlimited PTO—rest and recharge time is non-negotiable.
• Mental health support, retirement planning, and financial protection.
• Professional development with clear career progression and learning budgets.
• Mission-driven culture where diverse perspectives drive real impact on people's health.