Bachelor's degree in nursing, healthcare administration, or related field
3 years of experience in utilization management or related field
Experience leading a team of utilization management professionals
Strong knowledge of regulatory requirements and industry standards
Relevant experience may substitute for the educational requirement on a year-for-year basis
Responsibilities
Demonstrate commitment to the organization's mission and excellence standards
Lead and manage a team to review and authorize medical services
Manage utilization management processes for resource efficiency
Utilize established guidelines for service review and authorization
Ensure medical services are necessary and appropriate
Implement activities per established policies and procedures
Ensure compliance with regulatory requirements and industry standards
Benefits
Comprehensive healthcare coverage
Retirement savings plan
Professional development opportunities
Flexible work arrangements
Paid time off and holidays
Full Job Description
About the Role:
The Manager, Utilization Management plays a vital role in overseeing the evaluation and authorization of healthcare services to ensure appropriate, cost-effective care delivery. This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for developing and implementing utilization management policies and procedures to ensure compliance with regulatory requirements and industry standards. The Manager, Utilization Management will lead a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate. The Manager, Utilization Management's role is vital in ensuring that patients receive the highest quality of care while managing costs for the organization.
Minimum Qualifications:
Bachelor's degree in nursing, healthcare administration, or related field
3 years of experience in utilization management or related field
Experience leading a team of utilization management professionals
Strong knowledge of regulatory requirements and industry standards
Relevant experience may substitute for the educational requirement on a year-for-year basis
Preferred Qualifications:
Master's degree in nursing, healthcare administration, or related field
Experience working in a managed care organization
Certification in utilization management or related field
Responsibilities:
Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
Lead and manage a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate.
Manage utilization management processes to ensure efficient and effective use of resources.
Utilize established utilization management guidelines to review and authorize medical services.
Ensure that 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.
About Independent Living Systems
Independent Living Systems is a healthcare services company that provides managed care services to Medicare and Medicaid beneficiaries. The company offers a range of services, including care coordination, disease management, and transportation services. Independent Living Systems serves a variety of populations, including seniors, individuals with disabilities, and those with chronic conditions. The company was founded in 2001 and is headquartered in Lauderdale Lakes, Florida.
