Alliance Health
Supervisor - Utilization Management Physical Health (Full Time, Remote, North Carolina Based)
What's your preference?
Job Description
- Req#: SUPER003268
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $113,990 annually
- Excellent fringe benefit package including Medical, Dental, Vision, Life, and Long-Term Disability coverage
- Flexible work schedules with hybrid/remote options
- Generous paid time off including vacation, sick leave, and holidays
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment promoting diversity and inclusion
What to Expect (Job Responsibilities):
- Provide oversight of Utilization Management processes related to physical health authorizations and quality improvement activities
- Train and develop staff, ensuring compliance with policies, procedures, and workflows
- Monitor and ensure the consistent application of medical necessity criteria for physical health services
- Facilitate inter-departmental collaboration to streamline service delivery for individuals and families
- Analyze community service needs and implement best practices to improve department performance
What is Required (Qualifications):
- Graduation from an accredited Nursing school with 5 years of experience in Utilization Management, or a Bachelor's degree in Nursing with 3 years of experience
- Current, active, unrestricted North Carolina license as a Registered Nurse
- Knowledge of Utilization Management principles, physical health conditions, and diagnostic treatment guidelines
- Strong written and oral communication skills
- Experience in acute clinical utilization review and project management within a healthcare environment
How to Stand Out (Preferred Qualifications):
- Experience with NCQA standards
- Proven ability to lead teams and resolve conflicts effectively
- Familiarity with authorization/re-authorization Utilization Management standards
- Proficient in using multiple software programs relevant to healthcare management
- Ability to assist with appeal efforts when medical care is denied by payor entities
#HealthcareServices #UtilizationManagement #RegisteredNurse #CareerOpportunity #RemoteWork
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
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.About the company
We are the managed care organization for public behavioral healthcare for the citizens of Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake counties.
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.