Remote Oregon Utilization Management Lead

Yamhill Community Care (YCCO); United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Yamhill Community Care (YCCO) is seeking a full-time Utilization Manager to oversee the Utilization Management team in a remote setting. The role focuses on day-to-day operations, regulatory compliance with Oregon Administrative Rules, and driving process improvements.

Responsibilities include supervising the team, coordinating with medical directors on peer reviews and medical necessity policies, and monitoring the program's effectiveness to ensure high-quality care and adherence to contracts.

Qualifications

• Bachelor's degree in Nursing or related healthcare field.
• Three or more years of experience supervising or leading teams.
• Two or more years of experience in Utilization Management.
• Knowledge of Medicare and Medicaid regulations.
• Ability to work collaboratively across teams and with external partners.

Responsibilities

• Oversee and supervise the Utilization Management team.
• Collaborate with medical directors to facilitate peer reviews and develop medical necessity policies.
• Implement process improvements and monitor the effectiveness of the Utilization Manager program.

Education

Bachelor's degree in Nursing or related healthcare field

Job description

Yamhill Community Care (YCCO) is seeking a full-time Utilization Manager to oversee the Utilization Management team in a remote setting. The role focuses on day-to-day operations, regulatory compliance with Oregon Administrative Rules, and driving process improvements.

Responsibilities include supervising the team, coordinating with medical directors on peer reviews and medical necessity policies, and monitoring the program's effectiveness to ensure high-quality care and adherence to contracts.