Manager, Utilization Management

Independent Living Systems • Miami, FL

2d

About The Position

The Manager, Utilization Management oversees the evaluation and authorization of healthcare services to support appropriate, cost-effective care delivery and efficient use of resources. The role develops and implements utilization management policies and procedures in accordance with regulatory requirements and industry standards, and leads utilization management personnel in reviewing and authorizing medical services for medical necessity and appropriateness. The position supports Independent Living Systems (ILS), its affiliated health plans Florida Community Care and Florida Complete Care, and their commitment to promoting quality of life and maximizing independence for vulnerable populations.

Requirements

• Bachelor's degree in nursing, healthcare administration, or a related field; relevant experience may substitute for the educational requirement on a year-for-year basis.
• At least 3 years of experience in utilization management or a related field.
• Experience leading a team of utilization management professionals.
• Strong knowledge of regulatory requirements and industry standards.

Nice To Haves

• Master's degree in nursing, healthcare administration, or a related field.
• Experience working in a managed care organization.
• Certification in utilization management or a related field.

Responsibilities

• Demonstrate commitment to Our Mission and model ILS Experience Standards of Excellence.
• Lead and manage a team of utilization management personnel reviewing and authorizing medical services.
• Manage utilization management processes to ensure efficient and effective use of resources.
• Use established utilization management guidelines to review and authorize medical services.
• Ensure medical services are medically necessary and appropriate.
• Implement utilization management activities in accordance with established policies and procedures.
• Ensure compliance with regulatory requirements and industry standards.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager