State Licensed Utilization Management Director

To lead the clinical and non-clinical utilization management teams for a managed care organization, the full-time State Licensed Utilization Management Director will manage the UM program, ensure compliance with standards, and collaborate with executives to align departmental initiatives in a remote setting. Key responsibilities Prepare and maintain Utilization Review Plan policies and procedures while ensuring timely review of prior authorizations and appeals Oversee quality improvement activities, including conducting audits and evaluating the program for improvement opportunities Collaborate with the Chief Medical Director and participate in committees to ensure alignment of UM program with corporate initiatives Required qualifications Bachelor's degree in a relevant area preferred Minimum of 10 years of utilization management experience in a managed care setting Experience with UM NCQA or URAC certification/accreditation Proven leadership experience managing clinical and non-clinical teams Analytical ability to assess medical records and identify trends