Opportunity for career advancement and growth within the organization
Flexible remote or hybrid work options available
Comprehensive benefits package, including medical, dental, and vision insurance
Generous vacation and sick leave policies, with the ability to roll over unused time
Supportive and mission-driven work culture that values integrity and innovation
What to Expect (Job Responsibilities)
Lead and coordinate client and external audits for Utilization Management operations
Develop and respond to Corrective Action Plans (CAPs) to ensure compliance
Collaborate with the Compliance Department to refine policies and procedures
Support and train Utilization Management staff on regulatory requirements
Track and report Utilization Management performance metrics to leadership
What is Required (Qualifications)
Bachelor’s Degree in Healthcare Administration, Public Health, Business Administration, or a related field
Minimum of 4 years of experience in Utilization Management or healthcare compliance focusing on CMS Medicaid and Medicare guidelines
Strong analytical and organizational skills with attention to detail
Exceptional written and verbal communication and interpersonal abilities
Proficiency in Microsoft Office Suite
How to Stand Out (Preferred Qualifications)
Familiarity with compliance programs, auditing processes, or systems like HSP / Meditrac
Experience in leading audits and compliance initiatives
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.