Manager, Utilization Management (Remote)

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change.

At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission.

We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 13 billion transactions annually, our influence is continually expanding. 

Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. 

Reporting to the Medical Director of Availity’s Intelligent Utilization Management, the Manager, Utilization Management will help us shape how clinical content is developed, implemented, and scaled across the Intelligent UM Platform.  The ideal candidate brings deep utilization management expertise, strong people leadership skills, and the ability to think programmatically about process design and quality assurance. This role combines hands-on development of clinical decision logic with leadership of a team of UM Nurse Analysts.

Why you want to work on this team:

• Lead a dynamic, collaborative group of UM Nurse Analysts who are working on innovative technologies to disrupt the status quo and solve the problem of prior authorization in healthcare.

• Opportunity to work directly on cutting edge AI technology and its application to the healthcare industry.

Role qualifications:

• Bachelor’s degree in nursing. You must be a Registered Nurse (RN).

• At least 4 years of experience in a Utilization Management program, either with a health plan or with a healthcare provider.

• Over two years of strong team leadership and managerial experience, with ability to oversee UM nurse analysts and manage day-to-day functions.

• Experience working with digital tools, structured content development, and coding (ICD-10, CPT) is strongly preferred

• “Computer smart” – General power user of technology and confident with navigating new technologies and applications.

• Comfortable working in a tech-enabled, fast-changing environment

You will set yourself apart:

• Strong strategic thinking and operational mindset.

• Ability to synthesize complex, abstract problems, and collaborate effectively with team members with diverse skillsets to create solutions.

• Self-starter who thrives in ambiguity and enjoys building structure.

• Experience with automation and AI-driven solutions for Utilization Management.

What you will be doing:

Team Leadership and Clinical Oversight

• Manage a team of UM Nurse Analysts; guide workload, assist in developing and measuring quality and efficiency metrics, and support development of team members

• Conduct regular feedback, coaching, and performance reviews

• Serve as a clinical escalation point for content development and interpretation

• Model high standards for clinical accuracy, collaboration, and innovation

Strategic Program Development

• Partner with Medical Director and other leader leaders to shape and evolve UM content workflows, QA processes, and best practices

Clinical Content Creation and NLP Support

• Interpret payer medical policies to develop logic-based decision trees

• Write clinical attestation questions and assign structured concepts to support automated UM decisions

• Contribute to natural language processing (NLP) model training through annotation and review

Cross-functional Collaboration

• Work closely with product, engineering, and data science teams to align clinical content with platform capabilities

• Support the rollout of new medical policies and product features with appropriate clinical logic.

• Serve as a customer-facing resource for UM Nurse oriented products

• Help ensure consistency and alignment between clinical content and engineering

• Identify opportunities for greater efficiency, scalability, and standardization in decision tree creation

• Help define team goals, key performance indicators, and documentation standards

• Contribute to strategic planning for clinical operations in coordination with cross-functional stakeholders

Availity culture and benefits:

• Availity is a certified “Great Place to Work”, a “Best Workplaces for Technology Companies”, a “Best Workplaces for Women” and a “Best Workplaces for Millennials”!

• Culture is important to us and there are many ways for you to make your mark here!

• We have several Diversity & Inclusion teams and various ways to engage with fellow Availity associates. “AvaiLadies”, “Beyond Black”, “HOLA”, “Availity Pride”, “VetAvaility” a Young Professionals Group and “She Can Code IT” a group for women in tech are some of the groups you can get involved in.

• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too!

• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one!

• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits.

• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.

• Interested in furthering your education? We offer education reimbursement!

• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

• Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process.

Interview process:

• Recruiter resume review 

• Manager resume review 

• Recruiter video interview

• Manager video interview

• Panel video interview

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success.  As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships.  The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.

Disclaimers:

Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.

Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify.

Click the links below to view Federal Employment Notices.

Family & Medical Leave Act  Equal Employment Law Poster  Pay Transparency  Employee Polygraph Protection Act  IER Right to Work Poster  Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers