Near mountains and the ocean!!!

My client, part of a strategically growing and respected Managed Care/Health Plan, is seeking a seasoned Director of Utilization Review/Management. As a premier employer, they offer an excellent compensation package, great benefits, as well as opportunities for advancement. The organization is committed to excellence and respect; and they pride themselves on their employee engagement programs, which provide inspiration and growth while fostering innovation and diversity.
Responsibilities will include, but are not limited to:
  • Managed care members’ performance across the continuum of care to include the complete transition of care to outpatient care
  • Leading of special projects, reviews of Utilization Management programs, and evaluation of performance as indicated by contract, regulatory, and/or accreditation requirements
  • Collects, analyzes, audits, and reports Utilization Management program trends and quality outcomes
  • Develops, implements, and monitors policies and procedures for contract and accreditation compliance
  • Provides clinical and operational oversight of each Utilization Management initiative, which include analysis of clinical data to drive performance improvement
  • Provides recommendations to senior leaders on healthcare strategies, product development, policy and procedure changes, and/or cost control opportunities
  • 5+ years of Utilization Management experience within a managed care/health plan environment
  • Progressive, successful leadership and change management experience
  • RN and Bachelor’s degree in Nursing or Healthcare Management (or similar)
If you believe you would be the right fit for this position, submit your resume in confidence to Carey Allen, Resource Specialist, at; or for further details, Carey can be reached at (813) 445-6570.

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