Registered Nurse Director of Utilization Management

Job Summary

A company is looking for a Senior Director, Utilization Management.

Key Responsibilities

• Oversee end-to-end Utilization Management functions for Duals populations, ensuring compliance with policies and procedures
• Collaborate with Medical Directors to guide clinical decision-making and uphold evidence-based standards of care
• Act as the key point of contact for health plan partners and internal leadership to address UM trends and challenges

Required Qualifications, Training, and Education

• Bachelor's degree and 10+ years of related experience, including prior management experience
• 5+ years of management experience preferred
• Expert knowledge of industry regulations, policies, and standards preferred
• RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred