Utilization Management Program Director

The Utilization Management Program Manager is responsible for CountyCare Health Plan’s Utilization Management (UM) program and vendor contract oversight for medical, behavioral, Long Term Services and Supports (LTSS), dental, vision, and pharmacy UM. Collaborates with CountyCare directors, clinical managers, providers, and vendors to facilitate appropriate, efficient and effective utilization of health care services in conjunction clinical programs, National Committee on Quality Assurance (NCQA) and State and federal requirements. Serves as UM point of contact providing expertise and analyzing data from various sources to design and implement initiatives resulting in timely and accurate service authorization and cost effective, quality health outcomes for CountyCare.

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