Seeking a Nevada Licensed Utilization Manager, the full-time remote position will oversee operational activities of Utilization Management and Appeals, focusing on policy development, team metrics review, and regulatory compliance. Key responsibilities: Manage the development and maintenance of policies and procedures to ensure compliance with regulatory guidelines Drive process improvement initiatives and collaborate with clinical leadership to address operational variances Educate and mentor staff on quality improvement, operational standards, and compliance requirements Required qualifications: Current, unrestricted Registered Nurse (RN) licensure or Licensed Psychologist in the state of practice Associate's degree in Nursing or advanced degree in Psychology Minimum of five years of experience in Utilization Management or related operations Experience in managed care and with data analysis and reporting Knowledge of NCQA and CMS accreditation standards preferred
Nevada Licensed Utilization Manager in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.