Manager, Utilization Management (Remote)

Manager, Utilization Management

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change.

At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission.

We're on a mission to bring the focus back to what truly matters patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 13 billion transactions annually, our influence is continually expanding.

Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem.

Reporting to the Medical Director of Availity's Intelligent Utilization Management, the Manager, Utilization Management will help us shape how clinical content is developed, implemented, and scaled across the Intelligent UM Platform. The ideal candidate brings deep utilization management expertise, strong people leadership skills, and the ability to think programmatically about process design and quality assurance. This role combines hands-on development of clinical decision logic with leadership of a team of UM Nurse Analysts.

Why you want to work on this team :

• Lead a dynamic, collaborative group of UM Nurse Analysts who are working on innovative technologies to disrupt the status quo and solve the problem of prior authorization in healthcare.
• Opportunity to work directly on cutting edge AI technology and its application to the healthcare industry.

Role qualifications :

You will set yourself apart :

What you will be doing :

Team Leadership and Clinical Oversight :

Strategic Program Development :

Clinical Content Creation and NLP Support :

Cross-functional Collaboration :

Availity culture and benefits :

Next steps :

After you apply, you will receive text / email messages thanking you for applying and then you will continue to receive more text / email messages alerting you as to where you are in the recruitment process.

Interview process :

Video Camera Usage :

Availity fosters a collaborative and open culture where communication and engagement are central to our success. As a remote first company, we are also camera-first and provide all associates with camera / video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships. The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.

Disclaimers :

Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. NOTICE : Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http : / / www.dhs.gov / e-verify .