Utilization Management Program Specialist

Job Summary

Utilization Management Program Specialist is a remote, full-time position responsible for coordinating and monitoring Utilization Management program objectives, supporting performance improvement projects, and ensuring compliance with State, Federal, and NCQA standards.

Key Responsibilities

• Support the development and evaluation of the annual Utilization Management work plan and program description
• Request and validate reports, identifying and escalating problematic areas impacting departmental goals
• Participate in the development and maintenance of Utilization Management policies and procedures

Required Qualifications, Training, and Education

• Associate's Degree or equivalent work experience required; Bachelor's Degree preferred
• Minimum of 3 years in clinical or service quality improvement required
• Minimum of 3 years in healthcare delivery required
• Managed health care experience preferred
• Experience with medical management systems and Electronic Health Records preferred