Washington State Licensed Director of Utilization Management

Job Summary

A company is looking for a Director of Utilization Management.

Key Responsibilities

• Provide leadership and strategic vision for Utilization, Denial Management, Payer Notification, and Payer Audit processes
• Implement best practice procedures for provider appeals, payer audit responses, and utilization review in compliance with guidelines
• Guide the development, organization, planning, and implementation of projects to enhance quality-driven outcomes

Required Qualifications

• Bachelor's Degree in Nursing (BSN), Health Administration, Nutrition, or a business-related field
• Master's Degree in Business, Public Health, or Healthcare Administration preferred
• Ten years of nursing experience in an acute care setting, particularly in managed care
• Five years of utilization management and/or case management experience
• Current Registered Nurse license in Washington State or Multistate License endorsement (MLS)