Utilization Management Market Operations Manager - RN Preferred - Must live in Nevada - Must hold NV license
Core
Manage operational activities, policies, and appeals for Utilization Management (UM) lines of business, ensuring compliance with regulatory and accreditation standards.
Role type
Market Operations Manager (Utilization Management)
Builds
Operational processes, policy frameworks, and compliance reporting for UM programs.
Domain
Healthcare / Managed Care / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Process controls, regulatory compliance (NCQA/CMS), staff resource management, policy development, change management, data analysis, outcome measurement, cross-functional collaboration
Preferred skills
Accreditation/auditing experience, Six Sigma, project management, quality control
Technologies
Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Visio)
Responsibilities
Develop and maintain policies and standard operating procedures; oversee committee reviews and audit preparations; drive process improvement using continuous improvement frameworks; manage policy changes from regulatory requirements; educate and mentor staff on compliance and quality; manage relationships with internal and external partners; design future state operation models.
Seniority
Mid-Senior level, hands-on management