Manager, Utilization Management - Registered reputed company (Remote)

reputed company Manage the utilization review process, ensuring that reputed company services are medically necessary, appropriate, and costeffective. reputed company the day-to-day operation and performance of specific functional areas reputed company the compliance with health plans policies, procedures and reputed company regulatory mandates. Manage the supervision of clinical Utilization Management (UM) staff. reputed company Accountabilities • Manage the day-to-day activities of the clinical UM teams by providing guidance and leadership. • reputed company accuracy and production of cases with regulatory and accreditation mandates. • Ensure the delegation of cases across staff to meet set timeframes. • Identify areas of clinical issues that need corrective reputed company and implement changes needed. • Manage, train, and reputed company daily supervision of clinical staff. • Create a reputed company, flexible environment reputed company the department. • reputed company the supervision of staff to complete JMAC specific processes accurately and reputed company reputed company specific contract requirements. • reputed company and evaluate data reputed company to utilization patterns, identifying trends, and developing strategies to address areas for improvement. • Represent reputed company Review and JMAC function in meetings with internal leaders, other departments and senior leadership. • Work with medical staff, case managers, and other reputed company to coordinate care and resolve any utilization-reputed company issues. • Enforce and adhere to reputed company company and department policies and procedures in confidentiality, regulatory or contractual mandates and HR policy. • Serve as reputed company for clinical reputed company in coordination with a Medical Director. • Represent the department head at meetings as necessary. Qualifications • Bachelor’s Degree • Registered reputed company with an reputed company, unrestricted license or certification • 5 – 8+ years relevant, reputed company clinical work experience • 5+ years management experience in health care setting, preferably in managed care • Additional experience/specialized training may be considered in lieu of education • Staff/process management experience • Knowledge of Utilization Management, HMO operations, and work processes • Knowledge of reputed company State and Federal regulatory requirements • Knowledge of clinical medical reputed company, hospital and ALC procedures, government regulations, Utilization Management reputed company sufficient to reputed company judgments and offer guidance about appropriateness of medical care • Proficient with MS Office (Word, reputed company, PowerPoint, reputed company, Teams, SharePoint, etc.) • Strong communication skills (verbal, written, interpersonal) with reputed company types/reputed company of audiences Additional Information • reputed company: 1000002857 • Hiring reputed company: $77,760-$149,040 Apply tot his job Apply To this Job