Director, Utilization Management Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and prioritize Utilization Management and associated projects, ensuring deadlines are met and requirements are fulfilled.

• Collect and prioritize business needs for departmental requests, including regulatory reporting.

• Evaluate program performance to discover opportunities for enhancement and promote best practices through knowledge sharing.

• Facilitate collaboration with clinical teams and stakeholders to guarantee effective coordination and communication.

• Aid in monitoring legislative and governmental activities while integrating clinical services.

• Back data-driven initiatives aimed at enhancing member outcomes and experiences.

• Spearhead and support readiness activities for new business and program launches.

• Create program documentation and operational workflows.

• Involve stakeholders to ensure alignment within the organization.

• Incorporate services and processes for new business lines as needed.

• Recruit, develop, and guide essential staff members.

• Support the UM Department with projects and various company and departmental initiatives, such as program descriptions, evaluations, policies, procedures, business requirements, contract compliance, and execution.

• Execute additional job-related tasks as requested.

⛳️ Requirements

• A Bachelor’s Degree or equivalent years of relevant work experience is mandatory.

• At least five (5) years of experience in medical management operations, leadership, program, or management is required.

• A Master’s degree in Health Care Administration along with two years of post-degree professional experience is preferred.

• A minimum of one (1) year of experience in Utilization Management is preferred.

• Experience in implementing programs with a focus on integration is preferred.

• Familiarity with Medicaid, Medicare, Commercial, and Managed Care is preferred.

• Proficient in Visio, Microsoft Word, Excel, PowerPoint, and Project.

• Strong written and verbal communication skills.

• Capability to work independently as well as within a team setting.

• Excellent organizational, time management, analytical, and problem-solving skills.

• Ability to oversee a project from inception to completion.

• Strong relationship-building skills and leadership attributes.

• Skills in training and teaching; acts as a change agent.

• Ability to think critically and lead strategically.

• Extensive knowledge across all areas within Health Services, including Behavioral Health, Case Management, Utilization Management, Integration, and Pharmacy.

• Current, unrestricted RN licensure is preferred.

• General office environment; may need to sit or stand for extended periods.

🏝️ Benefits

• Bonus linked to company and individual performance may be offered.

• A substantial and comprehensive total rewards package is available.

• Total well-being support provided.

• Opportunity for remote work arrangement.

• Some travel may be necessary to fulfill the responsibilities of the role.