Utilization Management Operations Liaison

Job Summary

Supporting the coordination and monitoring of Utilization Management program objectives, the full-time remote Utilization Management Clinical Admin Operations Liaison will manage performance improvement projects, assist with policy writing, and provide clinical insights for operational efficiency.

Key responsibilities

• Collaborate with corporate and market UM leadership to develop and evaluate the annual UM work plan and program description
• Request and validate reports, identifying and escalating issues that may impact departmental goals
• Participate in the development and maintenance of UM policies and procedures, ensuring compliance with regulatory standards

Required qualifications

• Bachelor's Degree preferred
• Minimum of 3 years in clinical or service quality improvement required
• Minimum of 3 years in Utilization Management Review Process required
• Managed Healthcare experience preferred
• Successful management of NCQA accreditation survey preferred