Quality and Utilization Management Specialist

Employer Industry: Healthcare Management Consulting

• Salary up to $93,000
• Access to comprehensive benefits including health, dental, vision, life, and disability insurance
• 401k retirement program with employer participation
• Paid time off and tuition reimbursement for professional development
• Recognized as one of the World’s Most Ethical Companies® and ranked #1 on Charlotte’s Healthiest Employers list
• Flexible remote work environment

• Coordinate interdepartmental efforts for monitoring and preparing submissions for Utilization Review state licenses
• Collaborate with legal and industry resources for regulatory research and compliance
• Support the development and implementation of quality improvement and utilization management initiatives
• Assist in maintaining accreditation program standards and client audits
• Document and track licensing requirements and application statuses

• Minimum of 2 years of applicable work experience
• High School Diploma or GED
• Experience with Utilization Management licenses nationwide
• Familiarity with NCQA/URAC accreditation processes
• Strong organizational skills and attention to detail

• Associate’s degree or equivalent experience in compliance
• Experience with internal auditing
• Ability to work independently and manage daily activities without direct supervision
• Demonstrated skills in written communication and document preparation

We prioritize candidate privacy and champion equal‑opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.

We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.