Pennsylvania Licensed Utilization Manager

Job Summary

A company is looking for a Manager of Utilization Management Review.

Key Responsibilities

• Direct day-to-day activities of Clinical Care Reviewers, overseeing performance in prior authorization and medical necessity determinations
• Prepare reports and conduct operational analyses to meet departmental and regulatory requirements
• Collaborate with community agencies and manage relationships with external entities to ensure resource access for members

Required Qualifications, Training, and Education

• Bachelor's Degree required
• Minimum of 3 years of clinical practice experience
• Minimum of 3 years of experience in utilization management reviews as a Registered Nurse within a managed care organization
• Experience leading a large remote team of clinical professionals
• Current and unencumbered licensure in Pennsylvania as a Registered Nurse or Nurse Licensure Compact