Nevada Licensed Utilization Manager

Job Summary

Seeking a Nevada Licensed Utilization Manager, the full-time remote position will oversee operational activities of Utilization Management and Appeals, focusing on policy development, team metrics review, and regulatory compliance.

Key responsibilities:

• Manage the development and maintenance of policies and procedures to ensure compliance with regulatory guidelines
• Drive process improvement initiatives and collaborate with clinical leadership to address operational variances
• Educate and mentor staff on quality improvement, operational standards, and compliance requirements

Required qualifications:

• Current, unrestricted Registered Nurse (RN) licensure or Licensed Psychologist in the state of practice
• Associate's degree in Nursing or advanced degree in Psychology
• Minimum of five years of experience in Utilization Management or related operations
• Experience in managed care and with data analysis and reporting
• Knowledge of NCQA and CMS accreditation standards preferred