Utilization Management Market Operations Manager - RN Preferred - Must live in Nevada - Must hold NV license

CareSource
Nevada, United States
Full Time
Remote
Manager
USD 83,000 – 132,800
Associate Degree
Healthcare Healthcare Life Sciences

Posted 2 months ago

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Excellent 4.7

Job summary

The Utilization Management (UM) Market Operations Manager oversees the operational activities of UM and Appeals, developing policies, managing team metrics, regulatory and statutory reporting, and leading process improvements. The role requires clinical leadership, data analysis, compliance with NCQA and CMS standards, and strong management skills, with a preference for RN licensure.

Responsibilities

The Utilization Management Market Operations Manager oversees operational activities, including policy development, team metrics, and statutory reporting for specific lines of business. They drive process improvement, mentor clinical staff, and manage relationships with internal and external partners to ensure adherence to regulatory and accreditation standards.

Qualifications

Change Management Communication Skills Data Analysis Leadership NCQA standards Process Improvement Project Management Quality Control Regulatory Compliance Reporting

Candidates must hold an Associate degree in Nursing or an advanced degree in Psychology, along with a current, unrestricted RN or Licensed Psychologist license in Nevada. A minimum of five years of experience in Utilization Management or related operations within a managed care environment is required.

English

Benefits

  • Comprehensive total rewards package
  • Performance bonus

Company

CareSource

CareSource

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Insurance
Location
Nevada, United States

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Excellent 4.7
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