RN- Utilization Review Director for WI
: Job Details :

Provide strategic direction and oversight of the day-to-day operation of utilization management function within the insurance plan. Ensure integration of utilization management functions with network strategy and claims processing. Oversee work with provider relations on resolving issues. Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives. Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs. Oversee implementation and maintenance of prior authorization codes for all clients. Requirements Licensure / Certification / Registration:Registered Nurse obtained prior to hire date or job transfer date required. Education:Bachelor's degree in nursing or diploma from an accredited school/college of nursing required. Master's degree...Director, Healthcare, Management, Experience