Director, Utilization Management Operations – Preferred Experience in Prior Authorization Strategies

Job not on LinkedIn

🕒 October 15

🇺🇸 United States – Remote

💵 $135.6k - $237.4k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Manage and prioritize Utilization Management and related projects • Ensure project timeliness and adherence to completion • Gather and prioritize business requirements, including regulatory reporting needs • Monitor program performance to identify improvement opportunities and standardize evidence-based practices • Lead collaboration with clinical teams and stakeholders • Monitor legislative and governmental activities and coordinate integration of clinical services • Support data-driven improvements to member outcomes and experiences • Lead readiness activities for new business and program implementation • Develop program documents and operational workflows • Engage stakeholders to ensure organizational alignment • Add services and processes for new lines of business • Recruit, develop and lead key staff • Assist with program descriptions, evaluations, policies, procedures, contract compliance and execution • Perform other job-related instructions as requested

🎯 Requirements

• Bachelor’s Degree or equivalent years of relevant work experience is required • Minimum of five (5) years medical management operations, leadership, program, or management experience is required • Master’s degree in Health Care Administration and two years of post-degree professional experience is preferred • 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 • Strong knowledge of Visio, Microsoft Word, Excel, PowerPoint and Project • Strong written and verbal communication skills • 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 across Behavioral Health, Case Management, Utilization Management, Integration and Pharmacy • Current, unrestricted RN licensure is preferred • Some travel may be required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support • Remote work arrangement • Equal opportunity and inclusive workplace environment