Utilization Management Healthcare Operations Team Leader

About the role

The Utilization Management Operations Team Leader oversees the day‑to‑day activities of a non‑clinical healthcare operations team, ensuring that authorization requests, referrals, fax intake and other utilization management tasks are completed accurately and on time.

Key responsibilities

• Lead UM Coordinators and support staff, monitoring attendance, productivity and schedule adherence.
• Coach team members, provide feedback, mentorship and promote engagement.
• Manage authorization queues, distribute workload and ensure timely processing of requests.
• Support turnaround‑time compliance, coordinate staffing needs and address workflow concerns.
• Track KPIs, identify performance trends and develop action plans for improvement.
• Ensure adherence to SOPs, client requirements, HIPAA and other regulatory standards.
• Partner with Quality Assurance, Training, Workforce Management and clinical teams to maintain service quality and audit readiness.

Required profile

• Proven experience in US healthcare operations, including claims processing and provider/member support.
• Demonstrated ability to lead teams, drive process improvement and uphold quality compliance.
• Strong understanding of healthcare policies, regulations and data‑privacy requirements.
• Excellent communication and collaboration skills for cross‑functional coordination.

Required skills

• US Healthcare Operations experience
• Claims processing
• Provider and member support
• Process improvement
• Quality compliance
• Team leadership