State Licensed Utilization Management Director

Job Summary

To lead the clinical and non-clinical utilization management teams for a managed care organization, the full-time State Licensed Utilization Management Director will manage the UM program, ensure compliance with standards, and collaborate with executives to align departmental initiatives in a remote setting.

Key responsibilities

• Prepare and maintain Utilization Review Plan policies and procedures while ensuring timely review of prior authorizations and appeals
• Oversee quality improvement activities, including conducting audits and evaluating the program for improvement opportunities
• Collaborate with the Chief Medical Director and participate in committees to ensure alignment of UM program with corporate initiatives

Required qualifications

• Bachelor's degree in a relevant area preferred
• Minimum of 10 years of utilization management experience in a managed care setting
• Experience with UM NCQA or URAC certification/accreditation
• Proven leadership experience managing clinical and non-clinical teams
• Analytical ability to assess medical records and identify trends