Manager, Utilization Management Coordination, Non-Clinical (Hybrid Remote)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Manager, Utilization Management (UM) Coordination oversees non-clinical inpatient and pre-service operations and reports to the Director of Utilization Management. This role provides leadership to UM Supervisors and their coordinator teams, ensuring timely, accurate, and compliant processing of authorizations and referrals in alignment with CMS and organizational standards.

The Manager is responsible for driving operational efficiency, staff development, and process improvement, while partnering cross-functionally to support continuity of care and overall service quality. This includes ownership of reporting, workflow oversight, and identifying opportunities to improve performance, accuracy, and team effectiveness.

This position is primarily remote, with periodic in-office presence at Alignment Health’s headquarters in Orange, CA (a few times per quarter, based on business need). Candidates outside of California must be able to travel as needed; travel is reimbursed in accordance with company policy.

While exempt, this role supports a team operating Monday–Friday, 8:00 AM – 5:00 PM Pacific Time and requires consistent leadership presence during standard business hours to provide oversight, guidance, and support for team operations and cross-functional collaboration.

Job Responsibilities:

• Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows.
• Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions.
• Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels.
• Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs.
• Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards.
• Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity.
• Lead root-cause analyses for escalated operational issues and coordinate corrective action plans.
• Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making.
• Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices.
• Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques.
• Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions.
• Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards.
• Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans.
• Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements.
• Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required.
• Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership.
• Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables.
• Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance.
• Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution.
• Collaborate with