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Director, Utlization - Medical Management

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Maitland, FL
$80,000 - $120,000
Job Type
Direct Hire
Dec 04, 2017
Job ID
Director, Utlization - Medical Management - MAITLAND, FL

Nice opportunity for an experienced leader to be part of a growing team.
                  Generous relocation- excellent analytic tools and support. 

- Direct medical management program including UM, case management, QI and credentialing.
- Develop department objectives and implement action plans to achieve objectives.
-  Evaluate and implement changes to medical service functions and performance.
-  Manage budget and forecast for strategic planning and key initiatives.
-  Coordinate with operating departments on research and implementation of best practices.
-  Statistical analysis of utilization data on programs.
-  Participate in NCQA, State, and/or other accreditations of the Plan..
-  Develop effective communication plans with external providers such as hospitals and State agencies.
-  Coordinate with Medical Director to educate and communicate expectations with providers.

Ideal Candidate Profile:

- Bachelor's degree in Nursing, related field, or equivalent experience.

-7+ years of nursing, quality improvement, and management experience in managed care. 

-Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. 

-RN license

-Experience in FL a strong plus