Manager Utilization Management at Blue Cross and Blue Shield of Kansas

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13621459 Are

you ready to make a difference? Choose to work for one of the most

trusted companies in Kansas.

• Why Join Us?
• Make a Positive Impact: Your work will directly contribute to

the health and well-being of Kansans.

• Family Comes First : Total rewards package that promotes the

idea of family first for all employees. Paid vacation and sick leave

with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals in a work environment that promotes

flexibility.

• Trust and Stability: Work for one of the most trusted companies

in Kansas with over 80 years of commitment, compassion and

community.

• Inclusive Work Environment: We pride ourselves on fostering a

workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total

• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

functions, including precertifications, concurrent reviews, alternative

care setting authorizations, and pre-service requests. This role ensures

evidence-based, complaint care across all lines of business while

partnering with internal teams, providers, and vendors to optimize

outcomes, drive quality improvement, and maintain regulatory

accreditation standards.

"This position is eligible to work hybrid or onsite in accordance with

our Telecommuting Policy. Applicants must reside in Kansas or Missouri

or be willing to relocate as a condition of employment."

What you'll do

• Lead Utilization Management operations for pre-service requests,

regulatory and accreditation requirements.

• Maintain current knowledge on industry trends, clinical research,

appropriate care and comprehensive Utilization Management practices.

• Support and advance quality management initiatives that measure,

including programs such as HEDIS, QRS, QIS, and Stars.

• Drive accountability and performance excellence across teams through

testing to ensure consistent Utilization Management decision-making.

• Serve as a Subject Matter Expert for URAC Health Utilization

as well as ensuring all jobs functions are performed within the

scope of the Kansas Nurse Practice Act.

• Manage departmental budgets responsibly, ensuring proactive and

• Act as the primary liaison for Blue Card care management activities,

partners to resolve provider issues and support special business

arrangements.

• Oversee vendor relationships through effective delegated oversight,

state and federal regulations, including CMS and Medicare Advantage

requirements.

• Use data insights to guide operational improvemen s, accelerate

that inspires exceptional work.

• Lead and develop UM staff, fostering a culture of accountability and

support workflow optimization.

What you need

Knowledge/Skills/Abilities**

Awareness and understanding of medical necessity, utilization patterns,

standards of practice, and health care environment as they relate to all

programs and staffing.

Demonstrated ability to communicate effectively across multiple channels

while maintaining professionalism and confidentiality.

Effective time management, independent decision-making, and

prioritization skills with flexibility to respond to changing

priorities. Ability to obtain and analyze utilization, system, and

workflow data.

Coordinates with procurement for vendor contracts.

Prepare and present information about medical necessity reviews to

internal and external customers.

Interpersonal skills to effectively and professionally handle sensitive

medical necessity,