Director, Utilization Management 1069195

St. Louis, MO

Post Date: 11/03/2017 Job ID: 136137 Job Category: Software Dev. - General/IT

Are you looking for a new and challenging opportunity? Do you have experience with nursing? Technology Partners can help you make your next big career move a reality.



Our client is currently seeking a talented person for a Director, Utilization Management position in Chesterfield, Missouri.



What You Will Be Doing:

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



What We Are Looking For:

  • #LI-AA1

  • *CB

  • Bachelor's degree in Nursing or equivalent experience.

  • 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. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

  • Licenses/Certifications: Current state's nursing license.



If this position sounds like you, WE SHOULD TALK!



Your better future is ready, and we want to put the right tools in your hands to get you there. Let's go!



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