Registered Nurse Utilization Management

A company is looking for a Director of Utilization Management Authorization and Claims.

Key Responsibilities

Directs the utilization management team to ensure compliance with policies and procedures

Oversees authorization reconciliation and claims processes for effective outcomes

Implements process improvements to enhance operational efficiency and member experience

Required Qualifications

Bachelor's degree and 7+ years of related experience, including management

4+ years of management experience preferred

Expert knowledge of industry regulations and standards preferred

Knowledge of claims issues related to authorizations highly preferred

RN - Registered Nurse - State Licensure and / or Compact State Licensure preferred