Director Of Utilization Management, Full Time, Boston Or Brockton, Ma

Director of Utilization Management, Full Time, Boston or Brockton, MAThe Director of UM at Harbor Health-Elder Service Plan (Program for All Inclusive Care for the Elderly/PACE) is responsible for the day-to-day support, direction & supervision of the UM at the Elder Service Plan. This includes developing systems, processes, and best practices to address and monitor the efficient and effective use of health care resources, with attention to the quality and appropriateness of care within a managed care environment.
We are seeking an RN with a BSN or Master's degree, along with 8+ years of experience in a health plan or managed care setting. Candidates should have in-depth knowledge of managed care medical management, including UM/CM, Grievance and Appeals, inpatient and outpatient services, medical policy, clinical claims review, and MassHealth and CMS requirements. Great interpersonal skills, strong organizational abilities, and supervisory experience are required.
Please apply online or contact J. Tranford at 617-533-2342 or ****** for more information.

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