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Manager of Utilization Management -Medicare

Job Type
12 Sep 2022
Overview Our client is seeking a Manager of Utilization Management to join their growing team. This role will be responsible for the oversight of the delegated functions of utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review. The Manager of Utilization Management will work in close collaboration with Medicare Compliance Officer on oversight and audit functions for delegated services. The position will also play a key role in developing policies and procedures within the organization. Top 3 Skills required: • 3+ years of recent experience in Utilization Review / Utilization Management • Bachelor's Degree in Nursing • RN with current unrestricted Massachusetts License What you need to know: • 100% remote opportunity (must live in the Eastern Time Zone) • Typical Schedule: Monday - Friday, 8-5 pm • Equipment Provided (Laptop, Monitor, Keyboard, Mouse) Qualifications: • Bachelor's degree or higher • Valid Registered Nurse (RN) license/certification in Massachusetts (MA) • Do you have experience working in a start-up environment? (yes) • 3+ years experience in any of the following: o acute care clinical nursing o Utilization Management o Utilization Review o Case Management (CM) o Quality Improvement o MCG/Milliman/InterQual • Any of the following licenses/certifications: o Valid Certified Professional Coder (CPC) o Valid Certified Coding Specialist (CCS) o Valid CPUM/CPUR/CPHM Why would a candidate want to work here? • Full Benefits (Medical, Dental, & Vision) • 401K + Company Match • Unlimited PTO • Competitive Compensation • Annual Performance Bonus (if applicable, details will be listed on the job) • Join a high growth company
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  • Job Reference: 710219680-2
  • Date Posted: 12 September 2022
  • Recruiter: Relode
  • Location: Oregon
  • Salary: On Application
  • Sector: Healthcare & Medical
  • Job Type: Permanent