Utilization Management Director

The Director of Utilization Management is a key leadership role responsible for overseeing the effective management of healthcare services for physical health services and long-term services and supports. This position requires strong leadership and management skills, as well as expertise in healthcare operations and management.

Key Responsibilities:

• Directs and coordinates the efficiency and productivity of utilization management functions.
• Ensures compliance with all contract requirements, state and federal regulatory requirements, and all applicable accreditation standards.
• Works closely with delegated entities, pharmacy, dental, and other vendors to assure integration, oversight, and efficiency of UM processes and functions.
• Leads the Utilization Management team in managing and continuously improving UM program design, policies, procedures, workflows, and correspondence.

Requirements:

• Bachelor's Degree or equivalent experience.
• Active RN license required.
• 7-10 years of managed care operations experience, including a minimum of five years of leadership experience in Utilization Management (UM) or nursing leadership.
• Minimum three years of management experience in a health plan environment with responsibility for managing the effective utilization of healthcare services, case/disease management, program development/management/evaluation, and quality improvement.