Utilization Management Manager - Remote in Idaho

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The Utilization Management (UM) Manager is responsible for the supervisory oversight and direction of UM department activities to include prior authorization for post-acute services, medical necessity determinations, concurrent and retrospective reviews and discharge planning functions. The UM Manager actively participates in management decisions to verify compliance with all contract requirements. This position is based in Idaho but can be worked remotely. If you reside in Idaho, you will have the flexibility to work remotely* as you take on some tough challeng

Directs the activities of the UM staff, with direct supervision by the medical director regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care and other clinical and medical management programs Aids, approves and intervenes, as needed, to determine medical necessity, appropriateness and extended length-of-stay decisions Assists inpatient care manager in UM of members with complex medical care involving numerous providers or frequent intervention Participates in State- or plan-required audits and complies with all reporting requirements by area of responsibility Oversees reporting and monitors potential high-cost cases, readmissions, UM statistics to include admits per thousand, bed days per thousand, length-of-stay and readmissions per thousand within 30 days of discharge Develops and implements action plans for improvement, as needed Liaisons with the national UM team to ensure use of best practices and adherence to state contract requirements