Utilization Management Manager

Become a part of our caring community Join the WI Market Medicaid team at Humana in as a Utilization Management Manager. In this role you will lead a team responsible for medical necessity reviews, provider outreach, and prior authorization operations for Medicare and Medicaid services. Reporting to the Director, Health Services, you will drive quality, compliance, operational performance, and continuous improvement while supporting a positive experience for providers and members. Job Responsibilities Lead nurses and support staff responsible for utilization management and prior authorization activities. Oversee medical necessity and level of care reviews for inpatient, outpatient, and behavioral health services using established clinical criteria and organizational guidelines.…