Quality and Utilization Management Specialist

Quality And Utilization Management Specialist

The Quality and Utilization Management Specialist will be the owner of, and the primary individual responsible for interdepartmental coordination of monitoring and preparing submissions for initial and renewal of Utilization Review (UR) state licenses. This role will work closely with legal and other industry resources to conduct regulatory research for licensing and compliance and working collaboratively with internal / external stakeholders to communicate current and relevant information and requirements.

This position will also support the Sr. Director, Quality and Utilization Management in developing, implementing, monitoring and updating quality improvement and utilization management initiatives as well as policies, procedures and processes. Provides support for URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company. This role will require to stay apprised of regulatory changes, guidance, and industry developments relating to compliance, quality, and utilization management.

Key Responsibilities

• Documenting and tracking of all licensing requirements and application statuses.
• Work with internal departments and outside vendor(s), as applicable, for the timely completion and submission of licensing requirements.
• Coordinate with legal to monitor all state licensing requirements and implement changes as identified.
• Provide support in developing, implementing, monitoring and updating quality improvement and utilization management initiatives.
• Assist with implementing and maintaining RBUM policies, procedures and processes.
• Support quality improvement initiatives, including but not limited to : monitoring, auditing, and tracking of Utilization Management Program.
• Coordinate with other departments and assist as needed in performing / monitoring required UM internal audits.
• Collaborating with management to develop quality assurance plans, working with employees to implement the strategies, and reviewing documents for accuracy.
• Assists with URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company.
• Assist with client audits and routine compliance tasks.
• Other responsibilities as assigned by Stanson management.

Required Qualifications

Work Experience :

Years of Applicable Experience - 2 or more years

Education :

High School Diploma or GED (Required)

Preferred Qualifications

Skills :

Experience :

Education :

Required Certifications / Licensing

Additional Job Requirements :

Working Conditions : Remote

Travel Requirements : No travel required

Physical Demands : Sedentary : Exerting up to 10 pounds of force occasionally, and / or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time.

Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $62,000 - $93,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills / experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges.

Employees also receive access to the following benefits :

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Employees receive :

Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.

Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply. EEO / AA / Disabled / Protected Veteran Employer.

Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to diversity_and_accomodations@premierinc.com or contact Premier Recruiting at 704.816.5200. Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier's Privacy Policy.