Director of Utilization Management (RN)- Hybrid
📍 Remote/Hybrid – 2 days per week in the office
A growing healthcare organization is seeking an experienced Director of Utilization Management to lead its Medicare UM department.
This is an exciting opportunity for a hands-on leader to oversee and develop the UM function as the department continues to expand.
Key Responsibilities:
- Lead day-to-day Utilization Management operations
- Oversee utilization review, case management, and precertification functions
- Develop and implement UM policies, procedures, and workflows
- Ensure compliance with CMS, Medicare, and applicable regulatory guidelines
- Monitor utilization trends, reporting, and department performance
- Lead, develop, and train the UM team
Qualifications:
- Active RN license
- Strong leadership experience in Utilization Management
- Direct Medicare Utilization Management experience is required
- Knowledge of CMS guidelines, InterQual, and Medicare regulations
- Experience managing teams and improving UM processes
Interested candidates or referrals are encouraged to reach out for additional details!
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Director of Utilization Management in New City at Green Key Resources
This position is listed as full time and able to be worked remotely. It was posted yesterday.