Position Purpose: Supervise the daily operations of the utilization management (UM) department
Supervise the daily operations of the UM staff
Ensure appropriate usage of resources in order to facilitate the UM process
Ensure compliance within applicable state program guidelines
Evaluate compliance policies and procedures and analyze/recommend enhancements
Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements
Identify opportunities for process improvements necessary to facilitate department functions
Educate staff as necessary to ensure consistent performance and adhere to standards
Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary
Qualifications:Education/Experience: 3+ years of utilization management/quality improvement experience. Working knowledge and understanding of basic utilization management and quality improvement concepts. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. License/Certification: Current state's LPN, LVN, or RN license.
Job Type: Full-time
Working knowledge and understanding of basic utilization management and quality improvement concepts: 3 years
utilization management/quality improvement experience: 4 years
experience as a lead in a functional area or managing cross functional teams on large scale projects: 3 years
Required license or certification:
RN, LPN, LVN
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