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State Licensed Utilization Manager
A company is looking for a Utilization Management Manager to provide oversight and operational leadership for the Utilization Management Program. Key Responsibilities Oversee and maintain clinical program productivity, KPIs, and performance standards Generate and analyze outcome reports to guide staff in improving clinical and financial outcomes Ensure compliance with confidentiality, HIPAA standards, and URAC regulations Required Qualifications Bachelor's degree in Nursing (BSN) or related education degree Five or more years of experience in a supervisory role managing healthcare programs Five or more years of experience in utilization management across various age groups and medical conditions Proficient knowledge of NCQA, URAC, or similar accreditation standards An active, unrestricted RN license in the state of residence
A company is looking for a Utilization Management Manager to provide oversight and operational leadership for the Utilization Management Program.
Key Responsibilities
Oversee and maintain clinical program productivity, KPIs, and performance standards
Generate and analyze outcome reports to guide staff in improving clinical and financial outcomes
Ensure compliance with confidentiality, HIPAA standards, and URAC regulations
Required Qualifications
Bachelor's degree in Nursing (BSN) or related education degree
Five or more years of experience in a supervisory role managing healthcare programs
Five or more years of experience in utilization management across various age groups and medical conditions
Proficient knowledge of NCQA, URAC, or similar accreditation standards
An active, unrestricted RN license in the state of residence