Express Healthcare is seeking compassionate to support Utilization Manager, a community-led, non-profit organization. For more information call, 808-792-7000.

Job Title: Utilization Manager

Location: Honolulu,HI

Employment Type: Full-Time

Salary: $100,000 - $110,000

This position is responsible for overseeing day-to-day operations while managing the Utilization Management (UM) program within the Quality Improvement (QI) framework. Core duties include optimizing processes to ensure effective, timely, and cost-efficient care management across medical, behavioral, and community health services. The role involves continuous service monitoring for continuity, necessity, and cost-effectiveness, along with process recommendations to the Director of Medical Management and the Chief Medical Officer.

Key Responsibilities:

• Care Coordination:Work with clinical department managers to oversee members care levels, ensuring services are aligned with patient needs. Monitor continuity and assess timeliness, cost-effectiveness, and medical necessity.
• Outlier and Disability Monitoring:Collaborate to identify high-cost or outlier cases, coordinating actions to minimize organizational risk and liability.
• Data Evaluation and Reporting:Assess data to identify utilization trends, pinpointing overuse or underuse of services. Evaluate member demographics to uncover patterns and design community interventions to improve health outcomes.
• Committee Support and Recommendations:Support the Senior Medical Director by preparing materials for UM Workgroup/Committee meetings. Relay UM Workgroup recommendations to the Provider Advisory Committee for review and approval.
• Individualized Care Planning:Partner with clinical managers and inpatient coordinators to create personalized, integrated care plans as needed for individual members.
• Performance Improvement and QI Initiatives:Gather UM data for use in performance evaluations and QI initiatives to meet program standards.

Utilization Management Requirements:

• 3-5 years or experience of Utilization Management
• State of Hawaii RN License
• Current BLS Certificate
• Familiar with Medicaid and Medicare regulations

Apply Today:

To learn more or for immediate submission, please reply to this ad with an updated resume, or contact us directly at

808-792-7000. #HIHEALTH