Utilization Management Program Manager

Good Samaritan is seeking a Utilization Management Program Manager to lead strategy, implementation, and evaluation of utilization management initiatives that support whole-person, value-based care for underserved patients. This role designs and optimizes workflows, analyzes utilization trends, and partners with clinical, care management, and finance teams to ensure appropriate, cost-effective services aligned with our faith-based, mission-driven focus on health equity. The Program Manager leads continuous improvement, supports staff training, and translates data into actionable insights to advance quality, stewardship, and access.

Responsibilities

• Lead design and oversight of utilization management programs to ensure appropriate, cost-effective care.
• Analyze utilization data, trends, and outcomes; develop dashboards and reports for leadership.
• Partner with clinical, care management, and finance teams to optimize workflows and resource use.
• Ensure adherence to clinical guidelines, payer requirements, and regulatory standards.
• Develop and monitor program metrics; drive continuous quality improvement initiatives.
• Train and support staff on UM policies, processes, and documentation standards.
• Engage providers to reduce avoidable utilization and improve care coordination.
• Prepare presentations and recommendations for executive and board-level stakeholders.

Required Skills

• Utilization management
• Healthcare data analysis
• Program management
• Care management workflows
• Clinical guidelines interpretation
• Quality improvement (QI)
• Healthcare regulations and compliance
• EHR/reporting tools
• Budgeting and resource planning
• Stakeholder communication