Telligen · 17 hours ago
Quality Improvement Manager - Utilization Management
Oklahoma City, OK
Full-time
Hybrid
Senior Level
5+ years expTelligen is one of the most respected population health management organizations in the country, seeking a Manager of Utilization Management to lead operational oversight and compliance for UM programs. This role is responsible for managing UM staff, ensuring adherence to regulatory standards, and driving continuous improvement initiatives.
Health Care
No H1B
Responsibilities
Manage the day-to-day operations of Utilization Management programs across multiple contracts and populations
Lead planning, implementation, evaluation, and ongoing management of UM workflows to ensure compliance with regulatory, accreditation, and contractual requirements
Monitor key UM performance indicators including timeliness, determination accuracy, appeal overturn rates, and documentation quality. When risks or gaps are identified, leads root cause analysis and corrective action planning
Ensure UM operations remain compliant with applicable federal and state regulations, client requirements, and accreditation standards (e.g., URAC)
Partner with Quality and Compliance teams to support audits, corrective action plans (CAPs), policies, procedures, and readiness activities
Lead continuous improvement initiatives focused on clinical consistency, medical necessity application, letter accuracy, peer review processes, and regulatory adherence
Maintain financial accountability for assigned UM contracts, including staffing models, productivity expectations, and budget adherence
Monitor operational performance against contractual service level agreements (SLAs) and utilization benchmarks
Participate in proposal development, pricing inputs, and operational feasibility discussions as a UM subject matter expert
Coach, guide, and direct UM staff to achieve individual, team, and organizational objectives
Ensure appropriate training, competency validation, and ongoing education for UM nurses, physician reviewers, and support staff
Foster a culture of accountability, clinical integrity, and continuous improvement consistent with Telligen’s Management Philosophy that managers coach, engage, and support people to achieve results
Represent Telligen in meetings with clients, providers, regulators, and internal stakeholders related to UM operations
Collaborate with Medical Directors, Compliance, Quality, and Operations leadership to resolve issues and improve service delivery
May present UM outcomes, trends, and improvement initiatives to internal or external audiences
Stay current on utilization management trends, regulatory updates, accreditation changes, and evolving medical management best practices
Perform other duties as assigned to support organizational goals
Qualification
Required
Four year degree in nursing, health care, business, public health or a related field and/or equivalent training and/or experience
Graduate of an accredited nursing program (ACEN, CCNE), with an active, unrestricted RN license
5 years experience in healthcare environment including care management and/or health care quality improvement
3 – 5 years managing projects and/or a professional staff
Demonstrated experience working in a fast paced and deadline driven environment
Up to 20% local and overnight travel
Preferred
Knowledge of the following healthcare quality principles:
Health care services, health care organizations and programs
Information management processes, electronic health records and healthcare information technology
Quality improvement concepts, principles and process tools
Basic statistics, data collection techniques, data analysis and graphic representation of data
Benefits
100% employee-owned company
Reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment
Company
Telligen
Telligen is a trusted partner for U.S. government health agencies.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
RheaAnn Frost-Clewell
Vice President Finance & Administration/CFO
Brian Barry
Vice President - Enterprise Solutions & CIO
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