Utilization Management Clinical Admin Operations Liaison

As part of the Utilization Management (UM) Administrative team, the UM Clinical Administrative Operations Liaison is responsible for the coordination and ongoing monitoring of UM program objectives, including support of performance improvement projects for service and clinical activities, integrating the quality improvement and efficiencies into all UM department activities. Supports the UM Administrative and Operations Team activities using clinical knowledge to provide insight for processes, policies, and reporting. Supports the overall operation of UM programs that meet or exceed applicable State, Federal and NCQA standards Under the direction of the Manager UM Administrative Operations and Audit, supports UM through policy writing and updates, development of program documents and updates, development of processes, report development and validation of reports prior to submission. Provides support and clinical insight as needed for external audits and accreditation surveys. Represents UM at Quality meetings to present changes, documents and work-plan required items.