This role is responsible for ensuring all decisions are precise and thorough, developing trend reports for management, and guaranteeing compliance with CMS requirements for UM policies and procedures Create and execute strategies to keep department processes efficient and cost-effective Set up and sustain UM Intake systems to maintain data quality and support UST’s goals in quality, productivity, and finances Promote operational excellence throughout all departmental activities Guide employees and management in building sound intercompany workflows Lead, coach, and develop training programs to ensure staff competency Manage a department audit and oversight program that focuses on ongoing quality improvement Implement regular reporting to inform management about process trends and performance Foster a positive work environment that encourages collaboration, transparency, and employee engagement Discover innovative ways to boost performance and provider/customer satisfaction Instill a commitment to quality within your team Oversee standards and processes for hiring and retaining department staff Balance workloads to maximize team effectiveness Directly supervise non-exempt staff according to company policies and relevant local laws and regulations Responsibilities include interviewing, hiring, performance management, training, planning, assigning work, performance reviews, rewarding and counseling employees, handling complaints, resolving issues, and supporting employee engagement

Qualifications:

Active mainland USRN license Three to five years of progressive experience in insurance or managed care; at least one year at a supervisory or lead level in insurance or managed care required Background in Utilization Management Demonstrated problem-solving skills and ability to share knowledge across corporate departments Experience setting up training programs and motivating staff in a quality-focused setting Strong leadership, mentoring, and team-building abilities Collaborative skills to empower others and ensure team success Effective verbal and written communication skills for sharing ideas, presenting facts, answering questions, and active listening Ability to present budget or cost information and answer related queries Workflow management, project multitasking, and deadline achievement capabilities Amenable to work night shifts