Director, Utilization Management Operations

Our take on this role

About this role

Manage utilization management projects, develop program documents and workflows, and coordinate clinical teams across CareSource programs. Some travel may be required to fulfill the role’s duties.

What could you bring from clinical work?

• Nurses: Working with clinical teams to use evidence-based practices could help you coordinate teams and standardize practices across programs.
• Social workers: Your experience coordinating behavioral health and case management services may help you develop workflows that integrate clinical services.

Full job description from CareSource

Job Summary:

The Director, Utilization Management Operations assists the UM Department with all open projects and progress towards company and department initiatives including program descriptions, evaluations, policies, procedures, new business requirements, contract compliance and execution, and all related activities

Essential Functions:
Manages and prioritizes UM and related projects, and ensures timeliness and adherence to completion
Responsible for gathering and prioritization of business requirements for departmental requests including regulatory reporting
Monitors performance across programs to identify improvement opportunities, leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
Leads collaboration with all clinical teams and other stakeholders to ensure coordination and communication
Assists with the monitoring of legislative/governmental activities with the goal of coordinating the full integration of clinical services, identifying opportunities and issues
Supports the ongoing, data-driven approach to improve outcomes and experiences for members
Supports and leads readiness activities for implementation of new business and programs
Develops program documents and operational workflows
Engages stakeholders to ensure alignment across the organization
Adds services and processes related to the development of new lines of business as required
Recruits, develops, and leads key staff
Perform any other job-related instructions, as requested

Education and Experience:
Bachelor’s Degree or equivalent years of relevant work experience is required
Master’s degree in Health Care Administration and two years of post-degree professional experience is preferred
Minimum of five (5) years medical management operations, leadership, program, or management experience is required
Minimum of one (1) year Utilization Management experience preferred
Experience implementing programs with focus on integration is preferred
Experience with Medicaid, Medicare, Commercial and Managed Care is preferred

Competencies, Knowledge and Skills:
Strong Knowledge of Visio, Microsoft Word, Excel, PowerPoint and Project
Strong communication Skills; written and verbal
Ability to work independently and within a team environment
Strong organizational, time management, analysis, and problem solving skills
Ability to manage a project from start to finish
Strong relationship building skills and leadership qualities
Training and teaching skills/change agent
Ability to think critically and lead with strategy
Comprehensive knowledge base crossing all areas within the Health Services Areas including: Behavioral Health, Case Management, Utilization Management, Integration and Pharmacy

Licensure and Certification:
Current, unrestricted RN licensure is preferred

Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Some travel may be required to fulfill the duties of the role

Compensation Range:
$135,600.00 - $237,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SW2

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