Gerente De Manejo De Utilizacion

Gerente De Manejo De Utilizacion

Regular

Exempt

GENERAL DESCRIPTION:

The Utilization Management Manager is responsible for overseeing the Utilization Management unit, ensuring effective implementation of policies, operational guidelines, and clinical protocols. This role involves leading and developing the team, monitoring performance, and driving compliance with organizational goals. The manager coordinates cross-departmental collaboration, manages work plans, tracks key metrics, and maintains accurate reporting. Additionally, they uphold confidentiality standards and foster strong relationships with internal and external clients to support efficient and compliant utilization management operations.

ESSENTIAL FUNCTIONS:

• Creates, develops, and updates unit work plans, policies, operational guidelines, and clinical protocols to use in the unit. Develops activities to comply with policies, operational guidelines, and clinical protocols.
• Responsible for ensuring compliance with the goals and objectives established for the Utilization Management unit.
• Collaborates with other departments to achieve goals and objectives set by the Company.
• Responsible for coordinating meetings with staff to keep them updated on the progress of the work plan, achievements, and corresponding metrics.
• Responsible for coordinating and/or providing a development plan for the unit's personnel.
• Responsible for developing unit compliance statistics and metrics.
• Maintains monthly statistics of the activities carried out in the department and ensures that the required reports for each business line are produced promptly, correctly, and completely.
• Maintains effective interaction with both internal and external clients.
• Knows and complies with the confidentiality policy and monitors to ensure compliance.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's degree in Nursing Sciences. Five (5) years of experience in a health care environment and supervising staff.

Certifications / Licenses: A valid Nursing and Registration license is required. Other: Knowledge of clinical criteria, ICD-10, and CPT.

Languages:

Spanish – Advanced (comprehensive, writing and verbal)

English – Advanced (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”