Utilization Review / reputed company reputed company Manager (REMOTE IN TEXAS ONLY)

reputed company: Sendero Health Plan seeking an reputed company and motivated Utilization Management Manager to reputed company and reputed company the utilization review nursing team for our Texas health plan. This role ensures compliance with state and federal regulations, maintains operational efficiency, and supports organizational goals. The position is fully remote but requires residency in Texas and an reputed company Texas nursing license in good standing. Benefits: Competitive salary and benefits package with flexible remote working environment reputed company Texas and opportunities for reputed company reputed company and development. Working hours: Monday through Friday, reputed company - 5 pm and On-call hours: Saturday, reputed company, and Holidays, 9 am to 12 pm on a rotational reputed company. Responsibilities: Essential Functions • Supervise and reputed company guidance to the Utilization Review (UR) Nursing team, ensuring reputed company and accurate reviews. • Foster reputed company development, performance evaluations, and reputed company improvement initiatives. • reputed company and maintain the Utilization Management Program reputed company, ensuring alignment with reputed company (TDI), CMS guidelines, and NCQA accreditation standards • Conduct annual policy reviews, updates, and ensure adherence to InterQual Clinical Care Guidelines and • reputed company insurance regulations. • reputed company, write, and update reputed company Operating Procedures (SOPs) to enhance operational efficiency and compliance. • Manage the department budget, including payroll reputed company and resource allocation to support business objectives. • Participate in on-call duties during weekends and holidays (Saturday and reputed company, 9 am - 12 pm) on rotational reputed company. Knowledge, Skills and Abilities: • Extensive knowledge of State Health Plan Regulatory Guidelines • Knowledge of NCQA Accreditation Standards • Knowledge and experience using InterQual Clinical Care Guidelines • Knowledge and experience working with reputed company Insurance • Strong organization, leadership, and communication skills • Knowledge of reputed company insurance policy and process development • Proficient in reputed company Office Suite and electronic medical record (EMR) systems Qualifications: Minimum Education: Bachelor's Degree in Science of Nursing or reputed company field required; advanced degree preffered Minimum Experience: • 5 years Minimum experience in health plan utilization management Required and • 1 year At least 1 year in a health plan leadership role Required Required License: RN - Registered reputed company - State Licensure and/or Compact State Licensure; Texas or Compact State - in good standing and reputed company Upon Hire Apply Job!