Provides administrative oversight and monitoring of the utilization review activities such as including Utilization Management Program (UMP) development and implementation. Supervises professional nursing staff performing utilization management functions ensuring that members receive care and services that meet the Balanced Budget Act (BBA) requirements for quality, timeliness and access. Implements the UMP to ensure that members receive care in the least restrictive setting by overseeing the consistent application of InterQual Criteria. Works with the Medical Director and Administrator of Utilization Management and Quality Improvement (UM/QI) in the successful implementation of the Quality Improvement Program as it relates to the UMP. Graduated from an accredited school of nursing with licensure as RN, at least three years of case management, utilization review, authorization process experience required, five years of acute care experience or combination of 5 years of acute and long term care (SNF) experience, one to two years of supervisory experience required. Recent managed care experience preferred, familiarity with Federal and State Medicaid regulations, Medicare, national accreditation standards, and HEDIS preferred, experience with long term care and supervisory experience preferred. If you are looking for new and exciting challenges and want to make a difference in your community please apply for positions directly through our website or you can mail or fax your resume and cover letter to (Follow up calls will not be necessary as all COMPLETED resumes will be processed): Fax: (808) 973-6345 Alohacare.org Location: Honolulu Compensation: Based upon experience Principals only. Recruiters, please don't contact this job poster. Please, no phone calls about this job! Please do not contact job poster about other services, products or commercial interests. hawaii