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Manager Utilization Management: Multiple locations (remote)
Remote UM Leadership positions in multiple locations including North Carolina (requires state residency) and Delaware. Representing UM in state interactions and audits. Leads a team of RN clinical care reviewers for large Medicaid MCO. Partners with local plan leadership, including case management and provider network operations to achieve optimal member outcomes and plan compliance with state contracts. Develops solutions for process improvements to drive UM system functionality. Responsible for final validation and sign off of UM report submissions. Reviews corrective actions and prepares summaries of UM activity to support compliance.
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