Manager of Utilization Management -Medicare

Overview

Our client is seeking a Manager of Utilization Management to join their growing team. This role will be responsible for the oversight of the delegated functions of utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review. The Manager of Utilization Management will work in close collaboration with Medicare Compliance Officer on oversight and audit functions for delegated services. The position will also play a key role in developing policies and procedures within the organization. Top 3 Skills Required: • 3+ years of recent experience in Utilization Review / Utilization Management • Bachelor's Degree in Nursing • RN with current unrestricted Massachusetts License What you need to know: • 100% remote opportunity (must live in the Eastern Time Zone) • Typical Schedule: Monday - Friday, 8-5pm • Equipment Provided (Laptop, Monitor, Keyboard, Mouse)

Qualifications

• Bachelor's degree or higher
• Valid Registered Nurse (RN) in Massachusetts (MA)
• Do you have experience working in a start up environment?
• 3+ years of experience in ANY of the following:
  • acute care clinical nursing
  • Utilization Management
  • Utilization Review
  • Case Management (CM)
  • Quality Improvement
  • MCG/Milliman/InterQual
• ANY of the following valid licenses/certifications:
  • Certified Professional Coder (CPC)
  • Certified Coding Specialist (CCS)
  • CPUM/CPUR/CPHM

• Have you worked for a health plan or Managed Care Organization? If so, when & where?

Benefits

Company

Our client is a Medicare Advantage health plan thoughtfully designed to serve our members.