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.
Manager, UM Operations Strategy – Implementation
Location
United States
Posted
5 days ago
Salary
$83K - $132.8K / year
Seniority
Senior
Job Description
Manager, UM Operations Strategy – Implementation
CareSource
• The Manager, Utilization Management (UM) Strategy & Implementation leads a dedicated team that supports the UM program through multiple functions with a focus on all regulatory and compliance functions. • Oversee and manage UM Operations oversight functions such as Corrective Action Plan (CAP) management, ongoing monitoring, and multiple audit activities. • Build and leverage effective cross-functional business relationships and influence action across multiple internal and external partners to support a culture of compliance. • Responsible for development and maintenance of documentation related to policy, workflow and process when applicable. • Identify process gaps and drive improvements towards UM compliance in all areas.
Job Requirements
- Bachelor’s Degree in nursing or related field is required
- Master’s Degree in Business or health care field preferred
- Minimum of five (5) years clinical or related healthcare industry experience is required
- Prior leadership experience 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 are strongly desired
Benefits
- Bonus tied to company and individual performance
- Total rewards package
- Comprehensive well-being support
Related Guides
Related Categories
Related Job Pages
More Operations Jobs
Reporting directly to the Chief Revenue Officer (CRO), the Vice President of Sales Operations is responsible for driving sales productivity, operational excellence, and revenue growth. Acting as a strategic partner and “right hand” to the CRO, this role identifies opportunities to improve sales efficiency, implements scalable processes and systems, and ensures the organization consistently meets or exceeds its revenue targets. The VP of Sales Operations oversees all aspects of sales operations, including forecasting, planning, deal management, compensation design, sales systems, analytics, and enablement. This leader works cross-functionally across Sales, Finance, Legal, HR, Marketing, and Product to align strategy with execution and build a high-performing, data-driven sales organization.
Strategy & Operations Manager, Driver Engagement
CurriTransforming the way construction and industrial supplies are delivered.
• Build scalable systems for ongoing driver feedback (surveys, NPS, roundtables, interviews). • Analyze quantitative and qualitative driver data to identify key pain points, opportunities, and priorities. • Lead pilot experiments (0 → 1) with clear hypotheses, metrics, and evaluation criteria; scale successful initiatives across the marketplace. • Partner with Ops, Product, and Support to influence and drive company-wide improvements to the driver experience. • Consistently report to leadership on driver engagement trends, risks, and opportunities.
Game Operations – Trading Analyst
PrizePicksPrizePicks is a sports betting company offering a fantasy platform where users can select players and teams to place bets on. With the mission of becoming the m
• Maintain accurate pre-game and in-game player projections for all markets. This includes, but isn’t limited to: NFL, NBA, MLB, NHL, CBB, and CFB. • Monitor player projections throughout the day and track any key information needed for projections • Manage risk and monitor projections accordingly utilizing modeling and quantitative analysis • Understand PrizePicks members' play patterns and adjust internal processes accordingly • Work with sport owners to implement strategies, best practices, and processes around key markets • Help set up standard operating procedures around PrizePicks game operations tasks
• Monitor daily order flow across US, Canadian, and UK 3PLs; catch stuck orders and exceptions before they become customer issues. Liaise with 3PLs on damaged inbound units, fulfillment errors, returns, and special projects. • Coordinate inbound shipments and receiving; track containers, follow up on discrepancies, and keep inventory records clean. Maintain accurate inventory data, flag low-stock SKUs, and partner on reorder timing. • Improve SOPs, automate manual work, and pull operational reports (shipping SLAs, return rates) to surface anomalies. • Work tickets in Commslayer alongside the CS team: WISMOs, address changes, refunds, replacements, returns, warranty claims. • Offer the right solution (education, sizing, replacement part, alternative SKU) instead of defaulting to a refund. • Reconcile credit notes, invoice and process sales orders, and keep accounting and inventory systems clean. • Improve Commslayer automation: canned responses, macros, AI agent training, KB content, routing rules.



