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 cust