Post to Multiple Job Boards



Now take benefits of multiple job boards and search engine posting.
Try it.



Job Director, Utilization Management Pennsylvania Harrisburg, PA

Director, Utilization Management

Skills:Harrisburg, PA   Salary: $100,000–$125,000 / yr    |  Location:Pennsylvania  ,  United States Of America

Views:58     Premium Listing


Position Purpose: Oversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy and objectives of Corporate and the health plan.
Oversee the operations of the referral management, telephonic utilization review, prior authorization, and case management functions.
Support and perform case management, disease management and on site concurrent review functions as necessary.
Provide support to Provider Relations issues related to Utilization issues for hospitals and physician providers.
Coordinate efforts with the Member Services and Connections Departments to address members and providers issues and concerns in compliance with medical management requirements.
Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for the prior authorization unit.
Develop, implement and maintain policies and procedures regarding the prior authorization function.
Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes.
Compile and review multiple reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting.
Qualifications:
Education/Experience: Bachelor's degree in Nursing or equivalent experience. 5+ years of nursing experience in an acute care setting or medical/surgical, pediatrics, or obstetric in a managed care environment. 1+ years of utilization management and/or case management experience. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
RN highly preferred.
Licenses/Certifications: Current state’s nursing license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Employee Status:
Regular
Job Level:
Director/Sr. Director
Job Type:
Regular

Name
Email @
Skills
Resume

Save me for future


Check Similar Jobs



Create Job Alerts



Recent Gigs

Design and deploy your website to Digital Ocean-($299)
Design and deploy your website to Digital Ocean.
About.
Not rated
Design and deploy your website to AWS.-($399)
Design and deploy your website to AWS.

About Me .
Not rated
Migrate your current website to AWS-($99)
Migrate your current website to AWS
About Me : I am a .
Not rated
1 article for your business-($2)
I will write 500 words article for your business/blog
.
Not rated
15+ private blog network links-($2)
I will promote your website with links from private network .
Not rated



Recent Projects

TV Aerials Sheffield-($1000-$50000)
Experienced TV Aerial Engineer Needs For Sheffield Area Shef
Independent Fright Dispatcher Looking For Owner operators-($0-$0)
If you need a Reliable Dispatch Service that will find YOU t
Personal Assistant-($500-$1000)
As a personal assistant (PA) you will work closely with seni
Freelance assistant-($100-$500)
hi, I need a freelance assistant for various tasks. It inclu
Freelance Website Developer -($1000-$2000)

This role is perfectly suited to a recent graduate loo