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Director of Utilization Management (RN)

A-Line Staffing Solutions Tigard Full-Time
$100,000.00 - $169,000.00 / year
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Registered Nurse / Director of Utilization Management -Tigard, OR

Looking for an experience Utilization Review / Supervisor / Registered Nurse to work for a large health plan in Tigard, OR.

**Relocation Assistance Available**

Salary: $100,000-$169,000

Director of Utilization Management Requirements:

  • 5+ years of nursing experience in an acute care setting or medical/surgical, pediatrics, or obstetric in a managed care environment.
  • 1+ years of utilization management and/or case management experience (2+ years preferred).
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
  • OR RN License

Director of Utilization Management Job Duties:

 

  • Oversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy and objectives of Corporate and the health plan.
  • Oversee the operations of the referral management, telephonic utilization review, prior authorization, and case management functions.
  • Support and perform case management, disease management and on-site concurrent review functions as necessary.
  • Provide support to Provider Relations issues related to Utilization issues for hospitals and physician providers.
  • Coordinate efforts with the Member Services and Connections Departments to address members and providers issues and concerns in compliance with medical management requirements.
  • Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for the prior authorization unit.
    Develop, implement and maintain policies and procedures regarding the prior authorization function.
  • Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes.
  • Compile and review multiple reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting.

 

Please Contact:

Katherine Skelton

586-710-0022

Email blocked - click to apply

utilization management, utilization review, concurrent review, case management, prior authorization, health plan, health insurance, acute care, manager, director, supervisor, referral management, disease management, provider relations, ccm, hedis, stars, msn, mba, bsn, mha, population health, medicare, medicaid, community health, hire, fire, training, mentoring 

Recommended skills

Utilization Management
Managed Care
Acute Care
Disease Management
Pediatrics
Medical Surgical Nursing
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A-Line Staffing began in 2004 with just two of us – a father and son with 30 combined years of experience started the company out of a basement in Warren, Michigan. We started our company with just one placement, and continue to build the company and our relationships – one placement at a time.

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