Director, Utilization Management Operations

🔥 0 minutes ago

🇺🇸 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, ensuring timely completion and adherence to requirements • Gather and prioritize business requirements for departmental requests, including regulatory reporting • Monitor program performance to identify improvement opportunities and leverage best practices and knowledge sharing • Lead collaboration with clinical teams and stakeholders to ensure coordination and communication • Assist with monitoring legislative and governmental activities and integrating clinical services • Support data-driven efforts to improve member outcomes and experiences • Lead and support 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 as required • Recruit, develop, and lead key staff • Assist the UM Department with projects and company and department initiatives, including program descriptions, evaluations, policies, procedures, business requirements, 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 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 • Current, unrestricted RN licensure is preferred • General office environment; may be required to sit or stand for extended periods of time

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support • Remote work arrangement • Some travel may be required to fulfill the duties of the role