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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.