Position Purpose: Supervise the daily operations of the utilization management (UM) department.
- Supervise the daily operations of the UM staff.
- Ensure appropriate usage of resources in order to facilitate the UM process.
- Ensure compliance within applicable state program guidelines.
- Evaluate compliance policies and procedures and analyze/recommend enhancements.
- Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements.
- Identify opportunities for process improvements necessary to facilitate department functions.
- Educate staff as necessary to ensure consistent performance and adhere to standards.
- Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary.
Knowledge/Experience: Nursing education. 3 - 5 years of utilization management/quality improvement experience. Knowledge and understanding of basic utilization management and quality improvement concepts.
License/Certificates: RN, LPN or LVN required.