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Manager, Health Care & Utilization Review
- 1116
- Nurse Opportunities
- Direct Hire
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Our client, a major insurance health plan that serves members nationwide, is seeking an experienced, qualified individual to direct their Department of Utilization Management (UM). Headquarters for this health plan is located in the Baltimore Washington corridor in a pleasant office setting.
The Manager for Health Care & Utilization Review will provide leadership and direction to the utilization management staff. The Manager is responsible for management of the health plan's utilization management department, including controlling utilization and health plan benefits, managing vendor agreements, and performing financial and utilization analysis.
This is a permanent position with competitive salary and an excellent benefits package which includes generous vacation leave.
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- Bachelor’s degree in business, statistics, actuarial science, or health care-related field
- 5 to 7 years in the field of health insurance
- 5 years management/supervisory experience in the health insurance environment
- Experience in supervising a professional staff
- Experience in the design and administration of utilization management programs
- Experience in dealing with utilization management external vendors
- Experience in the design of cost containment programs
- Excellent understanding of the health insurance field including customer service, claims, provider relations and managed care