Director of Utilization Management

America’s Health Choice Medical Plans, Inc. a Medicare HMO, located in Vero Beach, FL has immediate opening for Director of Utilization Management!!Responsibilities:
Provides direct supervision for the daily operations of the utilization management personnel and assures medical resources are appropriately utilized.Supports provision of high quality, cost-effect clinical care in efficacious relationship with health care providers.
Effectively channels utilization to high quality, low cost providers in the least intensive appropriate clinical setting.Manages health plan risk effectively.
Supports maintenance of marketable, high quality, cost effective provider network.Responds to medical service questions in a timely manner.
Integrates case management program into utilization management functions.
Monitors and reports timeliness of all UM processes and program progress. Evaluates the utilization management program.
Manages operation of authorization, concurrent review and retrospective review programs.
Assures medical action plans are well conceived, targeted appropriately and executive effectively.Analyzes utilization patterns to identify aberrations and develop/implement corrective action plans.
Supports and participates in physician, hospital and ancillary provider education.
Assists in monitoring the provider network needs and makes recommendations for changes.
Assists the Medical Director in meeting regulatory and accreditation standards.
Qualifications/Requirements:
3-5 years clinical Nursing – Nursing license in state of Florida.
Bachelors/Master's degree in nursing, health administration or related field.
3 years experience in acute care UR in managed care or related work in Health Services with emphasis on education, protocol development, and administration. Management experience preferred.
Registered Nurse.
Computer skills: MS Office and prefer Med Direct and MBS Solomon.For immediate consideration, please "apply online" with your resume. Include your resume as part of your e-mail, NOT as an attachment (to maximize legibility). Please include current salary and salary history.Equal Opportunity Employer / Drug-Free Workplace.
CareerBuilder Keywords:Managed care, health care, nurse, utilization review, Medicare, LPN, RN, quality improvement, registered nurse, utilization, utilization management, HMO.
REQUIREMENTS



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