Clinical Utilization Management Leader

6 days ago


Troy, Michigan, United States Integra Partners Full time

At Integra Partners, we're committed to reimagining access to in-home healthcare and improving the quality of life for our communities.

Salary

$115,000.00 per year

Job Description

We're seeking an experienced Clinical Utilization Management Manager to lead our team and ensure timely and accurate utilization management decisions. The ideal candidate will have a strong background in nursing, with a minimum of 5 years of experience in utilization management in a managed care or payor environment.

This is a remote opportunity that allows you to work from home while making a difference in the lives of our members. As a Clinical Utilization Management Manager, you'll be responsible for:

  • Overseeing the day-to-day operations of the Utilization Management department
  • Ensuring compliance with regulatory requirements and health plan policies
  • Maintaining the quality of care provided by the department
  • Providing leadership and direction to the team of LPNs, RNs, and utilization management coordinators

The successful candidate will have excellent communication and leadership skills, with the ability to work effectively in a fast-paced environment. They'll also have proficiency in Microsoft Office applications and health plan systems.

Requirements

To be considered for this role, you'll need:

  • A Bachelor's degree in nursing (BSN)
  • Registered Nurse (RN) licensure
  • Minimum of 3 years of nursing experience in an acute or outpatient setting
  • Minimum of 5 years of UM experience in a managed care, payor environment
  • Experience with New York Medicare and Medicaid
  • Knowledge of regulatory requirements related to utilization management, such as CMS and NCQA standards

We offer a competitive compensation package, including a salary range of $115,000.00 per year, plus benefits such as medical, vision, and dental insurance, 401(k) retirement program, and paid time off. If you're passionate about making a difference in the lives of our members and have the skills and experience required for this role, we encourage you to apply.

We are actively seeking new colleagues in multiple locations across the United States, including Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.



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