Director of Utilization Mgmt - MediGold

Job description

Employment Type: Full time Shift: Description: Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Position Purpose: Director Utilization Review directs the department's activities and resources to ensure alignment with the mission, values, and objectives of the department and organization What you will do: Develops and implements departmental strategic goals, plans, and standards consistent with the clinical, administrative, legal, and ethical requirements/objectives of the organization. Oversees compliance with regulations, laws and ethics via audits and direct observation. Provides leadership in developing and implementing standardized tools, roles and systems to support Utilization Review Directs and evaluates departmental operations. Leads operational improvements to facilitate standardization of utilization...