Director of Utilization Management, Full Time, Boston or Brockton, MA - Oklahoma City, United States - Cmsne

Description

Director of UM at Harbor Health-Elder Service Plan

The Director of UM at Harbor Health-Elder Service Plan (Program for All Inclusive Care for the Elderly/PACE) is responsible for the day-to-day support, direction & supervision of the UM at the Elder Service Plan, developing systems, processes and best practices to address and monitor the efficient and effective use of health care resources, with attention to the quality and appropriateness of care within a managed care environment.

Qualifications:
RN w/BSN or Masters

8+ yrs of experience in health plan or managed care setting

In-depth knowledge of managed care medical management including UM/CM, Grievance and Appeals, inpatient and outpatient services, medical policy, clinical claims review, MassHealth and CMS requirements

Great interpersonal skills

Highly organized

Supervisory experience required

Please apply online at

or contact J. Tranford, or

for more information.

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