Utilization Management Lead

Independent Living Systems, llc; Miami (FL); On-site; USD 100,000 - 130,000; Full time

Job summary

Independent Living Systems (ILS) in Miami, FL is seeking a Manager, Utilization Management to oversee the evaluation and authorization of healthcare services, ensuring medical necessity and cost-effective care. You will lead a team and develop policies to align with regulatory standards.

Minimum qualifications include a Bachelor's in nursing or health administration and 3 years in utilization management; Master's preferred; certification is advantageous.

Qualifications

• Bachelor's degree in nursing, healthcare administration, or related field.
• 3 years of experience in utilization management or related field.
• Experience leading a team of utilization management professionals.
• Strong knowledge of regulatory requirements and industry standards.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Responsibilities

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
• Lead and manage a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate.
• Manage utilization management processes to ensure efficient and effective use of resources.
• Utilize established utilization management guidelines to review and authorize medical services.
• Ensure that medical services are medically necessary and appropriate.
• Implement utilization management activities in accordance with established policies and procedures.
• Ensure compliance with regulatory requirements and industry standards.

Skills

Team leadership

Utilization management

Regulatory knowledge

Healthcare compliance

Education

Bachelor's degree in nursing/healthcare administration

Master's degree preferred

Job description

Independent Living Systems (ILS) in Miami, FL is seeking a Manager, Utilization Management to oversee the evaluation and authorization of healthcare services, ensuring medical necessity and cost-effective care. You will lead a team and develop policies to align with regulatory standards.

Minimum qualifications include a Bachelor's in nursing or health administration and 3 years in utilization management; Master's preferred; certification is advantageous.