Description

The Utilization Management Program Manager at Good Samaritan leads strategy, implementation, and continuous improvement of utilization management across our faith-based, community health center. This role designs data-driven UM programs that balance access, quality, and cost while advancing health equity for underserved patients. The manager partners with clinical, behavioral health, dental, and administrative leaders to optimize authorization workflows, reduce denials, and support whole-person care. Responsibilities include performance analytics, compliance with payer and regulatory requirements, process improvement, and staff training. Ideal candidates bring strong healthcare program management, managed care, and analytics skills, plus a passion for mission-driven service.
Lead design and optimization of utilization management programs across Good Samaritan services
Use data to monitor utilization, quality, and cost outcomes; develop improvement plans
Partner with medical, behavioral health, dental, and admin leaders to align UM with whole-person care
Ensure compliance with payer, regulatory, and accreditation requirements
Develop and track program KPIs, dashboards, and regular leadership reports
Coordinate UM workflows, policies, and training for clinical and administrative staff
Engage in payer contracting/authorization strategy to reduce denials and delays in care
Support care management and population health initiatives to advance health equity
Manage program timelines, resources, and budgets while driving efficiency
Champion mission-driven, faith-informed, patient-centered utilization decisions
Utilization management
Healthcare program management
Data analysis and reporting
Managed care principles
Clinical guidelines & medical necessity criteria
Process improvement (Lean/Six Sigma basics)
Stakeholder & vendor management
Healthcare regulations & compliance
Electronic health record (EHR) systems
Budgeting and resource allocation
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
401k
RN, LCSW, or other clinical license (preferred, not required)
CPHQ, CCM, ACM, or similar quality/case management certification (preferred)
PMP or formal project management training (a plus)