A Day in the Life of the Director of Utilization Management:
The Director of Utilization Management is responsible for developing and implementing a Utilization Management Program that is consistent with the philosophies of Meridian. By directly overseeing several hundred Meridian Family Members, this leader holds a critical role in ensuring that Meridian's Utilization Management strategies are industry leading.
Design, develop, and implement a comprehensive utilization management strategy for the organization
Oversee the identification, tracking, resolution and response to all denials and appeals in compliance with NCQA, URAC or general accreditation standards
Promote a provider-friendly, customer service oriented philosophy within the Utilization Management department
Represent MHP at external meetings with provider groups to address issues, improve communication and educate providers regarding MHP’s utilization management process
Ensure that there are appropriate policies and procedures in place to support all utilization management and case management activities
Ensure that all department activities are in compliance with the NCQA, URAC or general accreditation standards, as well as State and federal regulatory requirements
Current license to practice as an LPN or RN in Michigan
Master's degree in nursing, health care administration, or related field is preferred
5 years of experience in Utilization Management
Previous management and supervisory experience
Additional Salary Information: Negotiable
Internal Number: 2018-5148
About Meridian Health Plan
Meridian Health Plan (Meridian) is a family-owned, family-operated health plan whose mission is to continuously improve the quality of care in a low-resource environment. Meridian currently offers plans in Michigan, Illinois, and Iowa.
In Illinois, Meridian is a Medicaid HMO providing health care to beneficiaries enrolled in the Family Health Plan and Integrated Care Program through a contract with the Illinois Department of Healthcare and Family Services.
Meridian began providing health services to Iowa Medicaid beneficiaries in 2012 through a contract with the Iowa Department of Human Services. It has since expanded to cover Wellness Plan beneficiaries.
Meridian is Michigan's largest Medicaid HMO, providing health care to Medicaid beneficiaries through a contract with the Michigan Department of Community Health.
Meridian’s affiliates include Medicaid and Medicare health and prescription drug plans, Meridian Choice a commercial plan available through the Health Insurance Marketplace, and MeridianRx a Pharmacy Benefit Management company.
To learn more, please visit our website, www.mhplan.com.