Manager, Utilization Management

Location: Tacoma, WA
Date Posted: 11-19-2017
Position Purpose: Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.
 
  • Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
  • Promote compliance with federal and state regulations and contractual agreements.
  • Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
  • Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease the business unit's financial exposure.
  • Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
  • Facilitate on-going communication between utilization management staff and contracted providers.
  • Develop staff skills and competencies through training and experience. Available to non-clinical staff as a resource for clinical questions.
     
Qualifications:
Education/Experience: Bachelor’s degree in related field or equivalent experience. Bachelor’s degree in nursing preferred. 3+ years utilization management and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of utilization management and clinical nursing. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. 
 
License/Certification: RN license. Case Management Certification preferred.Dental:Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years utilization management and recent experience in a clinical setting. Thorough knowledge of utilization management and clinical nursing or dentistry. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. License/Certification: Possess an active, professional and unrestricted license as a Registered Nurse (RN) or Registered Dental Hygienist (RDH) to practice as a health professional in a state or territory of the United States. 
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
"Bringing Talent to the Marketplace"

KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!



 
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