Director, Utilization Management & Operational Excellence

Medical Mutual; Brooklyn (OH); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Employee bonus program

401(k) with company match

Tuition reimbursement

On-site cafeteria

Fitness center access

Job summary

Medical Mutual is seeking a leader in utilization management in Brooklyn, OH. This hybrid role requires directing operations relating to both Commercial and Medicare acute and post-acute care services, ensuring regulatory adherence and guiding clinical staff training.

The ideal candidate will possess a Bachelor of Science in Nursing, a minimum of 8 years of related experience, and a strong understanding of healthcare regulations. This position offers competitive benefits and supports employee development through hands-on coaching and education incentives.

Qualifications

• 8 years progressive experience in managed care utilization management.
• 5 years leadership or project management experience.
• Registered Nurse with unrestricted license required.

Responsibilities

• Directs operations related to Commercial and Medicare care services.
• Analyzes trends and implements departmental initiatives.
• Leads management of key performance indicators.

Skills

NCQA accreditation knowledge

HIPAA compliance

Microsoft Office skills

ICD 10 and CPT knowledge

Strong communication skills

Education

Bachelor of Science in Nursing

Master's degree preferred

Job description

Medical Mutual is seeking a leader in utilization management in Brooklyn, OH. This hybrid role requires directing operations relating to both Commercial and Medicare acute and post-acute care services, ensuring regulatory adherence and guiding clinical staff training.

The ideal candidate will possess a Bachelor of Science in Nursing, a minimum of 8 years of related experience, and a strong understanding of healthcare regulations. This position offers competitive benefits and supports employee development through hands-on coaching and education incentives.