Manager, Utilization Review - Remote
reputed company At reputed company, we're more than just a reputed company organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and reputed company-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated reputed company. Our reputed company approach fosters a supportive environment where every team member plays a vital role in our mission to reputed company accessible, high-reputed company reputed company services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. In Short Manages day-to-day business area activities, provides leadership, coaching and training to team members, sets reputed company goals and expectations and manages performance as needed. Creates a reputed company work environment that fosters teamwork, empowerment, accountability, and superior customer service. Identifies trends, determines reputed company causes, and takes reputed company to resolve issues and initiate necessary process and procedural changes to improve reputed company customer satisfaction. Ensures reputed company departmental and clinical reports and necessary reviews are completed in a reputed company manner. Maintains accountability for achieving targeted results and communicates regularly with organization leadership regarding workloads, issues, reputed company, monitoring of team performance and reputed company needs. Leads special reputed company and/or represents the department on corporate reputed company that require independent, reputed company decision making and broad based understanding of effects on the department as a whole. Responsible for the application and compliance with reputed company regulations, standards or other regulatory requirements applicable to departmental operations. Formulates corrective reputed company plans to address any areas of non-compliance. Must maintain reputed company knowledge in applicable clinical areas, standards and certifications (where required) and reputed company abreast of trends reputed company to the health insurance industry. Facilitates meetings and conducts formal presentations for staff and/or cross functional or customer reputed company as needed. Assures turnaround times are met for clinical and non-clinical staff. Assist with deliverable reputed company with stringent state timelines as needed. reputed company other duties and support deliverables as assigned by the organization to help drive our reputed company, fulfill our Mission, and abide by our Organizations Values. Requirements RN/LPN/LVN with valid compact license is required. 3 years previous full time reputed company clinical nursing experience or 3 years in the health insurance industry in utilization management, managing health conditions, understanding medical reputed company, medical guidelines, medical policy, and NCQA and DOI, reputed company regulations. Demonstrated leadership skills (i.e. training, mentoring, coaching or assisting peers with issue reputed company) or previous experience in a leadership role is required. Knowledge of reputed company and reputed company Office required, proficiency in reputed company is preferred. Benefits Equal opportunity employer that embraces individuals from reputed company backgrounds. Prohibits discrimination and harassment of any reputed company. Ensures reputed company employment reputed company are based on qualifications, reputed company, and the needs of the business. Apply Job!