Utilization Management Market Operations Lead — Process Improvement

CareSource mission; United States; À distance; USD 83 000 - 133 000; Plein temps

Avantages offerts par ce poste

Bonus tied to performance

Résumé du poste

CareSource is seeking a Market Operations Manager for Utilization Management to oversee UM and Appeals operations and policy development across specified lines of business. The role emphasizes governance, metrics review, audit prep, and annual program planning.

The ideal candidate will lead cross-functional teams, drive process improvements, and ensure compliance with NCQA, CMS, and other standards. A nurse or psychology credential with 5+ years in managed care is preferred, with strong data

Qualifications

• Associates degree in Nursing or advanced degree in Psychology required.
• Minimum of five years in UM or related operations.
• Managed care experience required.
• Experience with analysis, data and reporting required.
• Accreditation, auditing, and process improvement experience preferred.

Responsabilités

• Oversee operational activities of UM and Appeals for specified lines of business.
• Develop and maintain policies and procedures.
• Review team metrics and prepare statutory reports.
• Lead change management and process improvement initiatives.
• Educate and mentor staff and clinical leaders on requirements and quality.

Formation

Associates degree in Nursing

Advanced degree in Psychology

Outils

Microsoft Office Suite

Regulatory reporting frameworks

Quality improvement methodologies

Description du poste

CareSource is seeking a Market Operations Manager for Utilization Management to oversee UM and Appeals operations and policy development across specified lines of business. The role emphasizes governance, metrics review, audit prep, and annual program planning.

The ideal candidate will lead cross-functional teams, drive process improvements, and ensure compliance with NCQA, CMS, and other standards. A nurse or psychology credential with 5+ years in managed care is preferred, with strong data