Utilization Management Director jobs in West Virginia

The Director of Utilization Management provides leadership, management, oversight, and assessment of all aspects of management and is responsible for managing overall utilization while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of UM works collaboratively with the Chief Medical Officer, Vice President of Medical Economics, Program Evaluation and Clinical Strategic Initiatives, Director of Case Management and Medical Directors, as well as other leaders to plan, organize, coordinate, develop the vision, perform implementation and measure the outcomes of all UM and A/G programs based on both governmental and non-governmental lines of business to ensure compliance to the requirements of all regulatory and accreditation bodies relevant to clinical management.

Required:

• Registered Nurse with a minimum of 5 years clinical experience.
• At least two years of experience should be in a management capacity.
• Minimum of a Bachelor of Science degree in Nursing or willingness to obtain within two years of hire.
• Holds active and unencumbered Ohio and West Virginia registered nurse license.
• Minimum of five years in a managed care organization.

Desired:

• Public speaking and excellent written communication skills, motivation and initiative, and ability to work independently.
• Superior work ethic.
• Experience in writing policies and procedures.
• Proven leadership abilities.
• Strong verbal, written, analytical, and interpersonal skills.
• Flexible and able to multi-task, work in a fast-paced environment and adapt to changing processes.
• Self-starter with strong entrepreneurial skills.
• Certification in related area preferred, Certified Managed Care Nurse (CMCN).

Responsibilities: