Humana·3 days ago
3 days ago
Utilization Management Manager
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What you'll do
- Lead a team overseeing medical necessity reviews, provider outreach, and prior authorization for Medicare and Medicaid
- Drive quality, compliance, and operational performance
What they're looking for
- Registered nurse license
- Leadership experience in clinical or operational settings
- Expertise in utilization management
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
We are looking for a Utilization Management Manager to lead a team overseeing medical necessity reviews, provider outreach, and prior authorization for Medicare and Medicaid. This role drives quality, compliance, and operational performance. Ideal candidates have leadership experience in clinical or operational settings and expertise in utilization management.
Skills
- utilization management
- registered nurse license
- prior authorization
- medicare utilization review
- medicaid utilization review
- medical necessity review
- provider outreach
- clinical criteria application
- level of care review
- process improvement
- operational performance metrics
- trend analysis
- policy implementation
- workflow management
- team leadership
- coaching
- performance management
- cross-functional collaboration
- excel macros
- healthcare compliance
- provider education
- resource management
Company
Humana
Remote, Wisconsin
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