Director, Utilization Management Operations
About The Position
The Director, Utilization Management Operations assists the Utilization Management Department with open projects and progress toward company and department initiatives. This includes program descriptions and evaluations, policies and procedures, new business requirements, contract compliance and execution, and related activities. The role manages and prioritizes projects, supports new business and program implementation readiness, develops program documents and workflows, and helps drive data-informed improvements in member outcomes and experiences. The Director also recruits, develops, and leads key staff and performs other job-related duties as requested. The position works in a general office environment, where sitting or standing for extended periods may be required. Some travel may be required. Compensation is listed as $135,600–$237,400, with potential eligibility for a bonus tied to company and individual performance. CareSource describes a substantial and comprehensive total rewards package but does not specify its components in the posting.
Requirements
- Bachelor’s degree or equivalent years of relevant work experience.
- At least five years of medical management operations, leadership, program, or management experience.
- 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, and ability to act as a change agent.
- Ability to think critically and lead strategically.
- Comprehensive knowledge across Health Services areas, including Behavioral Health, Case Management, Utilization Management, Integration, and Pharmacy.
Nice To Haves
- Master’s degree in Health Care Administration and two years of post-degree professional experience.
- At least one year of Utilization Management experience.
- Experience implementing programs focused on integration.
- Experience with Medicaid, Medicare, Commercial, and Managed Care.
- Current, unrestricted RN licensure.
Responsibilities
- 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, leverage best practices, and share knowledge to improve outcomes through standardized evidence-based practices.
- Lead collaboration with clinical teams and other stakeholders to support coordination and communication.
- Assist with monitoring legislative and governmental activities to coordinate integration of clinical services and identify opportunities and issues.
- Support a data-driven approach to improving member outcomes and experiences.
- Support and lead readiness activities for implementation of new business and programs.
- Develop program documents and operational workflows.
- Engage stakeholders to ensure alignment across the organization.
- Add services and processes related to developing new lines of business as required.
- Recruit, develop, and lead key staff.
- Perform other job-related instructions as requested.
Benefits
- Potential eligibility for a bonus tied to company and individual performance.
- A substantial and comprehensive total rewards package is offered; specific benefits are not listed.
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What This Job Offers
Job Type
Full-time
Career Level
Director
