Job Summary
A healthcare provider needs applicants for an opening for a Telecommute Training and QA Utilization Manager Director.
Individual must be able to fulfill the following responsibilities:
- Monitor all activities related to medical review
- Develop on-site processes where indicated with direct oversight of centralized telephonic review process
- Develop and adopt best practice methodologies and training programs
Skills and Requirements Include:
- Associate’s Degree or equivalent Diploma in Nursing or related healthcare field
- Active license as (LPN), (LPC), (LCPC), (LCSW), or (RN, RNC)
- Five (5) to seven (7) years of progressive experience in utilization management in a health plan
- Working knowledge of activities such as prior authorization, concurrent review, intake, appeals and grievances
