Texas Licensed Clinical Nurse Director

A company is looking for a Director of Utilization Management.

Key Responsibilities

Develop and implement strategic plans for Utilization Management aligned with organizational goals

Direct all UM activities including prior authorization, concurrent review, and appeals

Ensure compliance with NCQA standards and lead accreditation activities

Required Qualifications

Bachelor's degree in Nursing, Healthcare Administration, or related field required

Master's degree in a related field preferred

Active RN license or other clinical licensure required

8-10 years of experience in utilization management or medical management

5 years in a leadership role overseeing UM operations