Utilization Management Director
2 days ago
We are seeking a highly skilled and experienced Utilization Management Director to join our team at All's Well. As a key member of our healthcare operations team, you will be responsible for providing comprehensive oversight of the Utilization Review process under the Knox Keene license and Department of Health Care Services contract.
Key Responsibilities- Provide strategic leadership and direction to the Utilization Review team
- Develop and implement effective utilization management strategies to ensure compliance with regulatory requirements
- Collaborate with cross-functional teams to identify and address areas for process improvement
- Develop and maintain relationships with key stakeholders, including healthcare providers and payers
- Stay up-to-date with industry trends and regulatory changes, and implement changes as necessary
- Bachelor's degree in Nursing or other relevant healthcare field required; Master's degree preferred
- Minimum of 4 years of management-level experience in Utilization Management in a managed care environment or healthcare industry
- Minimum of 4 years' clinical experience in Utilization Review or Case Management in a Health Plan or similar payer/provider setting
- Valid driver's license and proof of State required auto liability insurance
- Bilingual (English/Spanish) preferred
We offer a competitive salary and benefits package, including major medical, dental, vision, 401k, and statutory sick pay where required. We are committed to working with and providing reasonable accommodations to individuals with disabilities.
We are an EEO/AA Employer/Vet/Disabled and participate in the E-Verify program in certain locations as required by law. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements.
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