Florida Licensed UM Operations Manager

Job Summary

Leading a dedicated team, the full-time Florida Licensed UM Operations Manager will oversee the Utilization Management program, focusing on regulatory compliance, prior authorization analysis, and cross-functional project management in a remote work environment.

Key responsibilities:

• Establish compliance baselines and develop strategies to align with organizational goals
• Manage oversight functions including Corrective Action Plan (CAP) management and audit activities
• Collaborate with internal and external partners to enhance compliance culture and processes

Required qualifications:

• Bachelor's Degree in nursing or related field is required
• Minimum of five years of clinical or healthcare industry experience is required
• Prior leadership experience is required
• Managed Care experience is required
• Fluency in NCQA and/or CMS accreditation and audit standards is preferred