North Carolina Licensed Utilization Management Director

Job Summary

To oversee physical health utilization management activities, the full-time remote North Carolina Licensed Utilization Management Director will manage staff, ensure compliance with regulations, and develop systems for monitoring service utilization while collaborating with various departments.

Key responsibilities

• Develop and implement goals and objectives for the Utilization Management Department
• Manage and develop staff to ensure compliance with policies and promote a positive work environment
• Oversee the review of physical health services and ensure adherence to medical necessity criteria and performance measures

Required qualifications

• Bachelor's degree in Nursing with seven years of post-degree experience, including two years in a supervisory role and two years in Utilization Management, or a Master's degree in Nursing with five years of experience
• Registered Nurse license in North Carolina
• Knowledge of Utilization Management principles and physical health conditions
• Experience in acute clinical utilization review and managing patient care providers
• Proficiency in Microsoft Office and data analysis for developing strategies