Utilization Management Director
hace 2 semanas
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.
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Director, Utilization Management
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Puerto Diablo, Puerto Rico Jobleads-Us A tiempo completoThe Director of Utilization Management leads and manages all utilization management (UM) functions for physical health services and long-term services and supports to ensure achievement of business results while maintaining compliance with all contract requirements, state and federal regulatory requirements, and all applicable accreditation standards. The...
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