Manager, Clinical Utilization Management & Transitions of Care

Job description

Who we are Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration. Our commitment is to: - Strive to a pply an equity lens to all our work. - Reduce health disparities. - Create an equitable work environment. About the Role: This position leads and oversees the team focusing on utilization management inpatient medical necessity reviews and transitions of care (TOC) efforts, including post-discharge outreach and onsite facility engagement, to support safe, timely, and effective transitions across care settings. This leader partners closely with the broader Utilization Management team, network facilities, and vendors to develop and optimize workflows that ensure regulatory compliance, operational efficiency, and high-quality member outcomes. The role plays a key part in driving performance across clinical quality, timeliness, and care coordination while strengthening relationships with providers and improving the overall member experience. To be successful in...