Missouri Licensed Utilization Management Director

Job Summary

Leading the utilization management team, the full-time Missouri Licensed Utilization Management Director will oversee the enterprise strategy and operational execution of hospice and palliative care management for Medicaid and Marketplace populations in a remote setting.

Key responsibilities

• Directs the utilization management team to ensure compliance with corporate and regulatory standards while improving member outcomes
• Analyzes utilization trends and implements process improvements to achieve cost-effective healthcare results
• Develops and executes strategies for onboarding, hiring, and training new team members to enhance care quality and compliance

Required qualifications

• Bachelor's degree with 7+ years of related experience, including prior management experience
• 4+ years of management experience preferred
• Expert knowledge of industry regulations, policies, and standards preferred
• Registered Nurse (RN) licensure highly preferred
• Experience creating pivot tables is required