Director, Utilization Management Operations(Preferred Experience in Prior Authorization Strategies)
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 supports data-driven improvements to member outcomes and experiences, develops program documents and operational workflows, and leads readiness activities for new business and programs. The Director also recruits, develops, and leads key staff. The position works across clinical teams and organizational stakeholders to coordinate communication, align initiatives, and integrate clinical services. It monitors program performance to identify improvement opportunities and encourage the standardization of evidence-based practices. Some travel may be required. The role is based in a general office environment and may involve sitting or standing for extended periods. The compensation range is $135,600 to $237,400, with potential eligibility for a bonus tied to company and individual performance. CareSource also offers a comprehensive total rewards package.
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, analytical, and problem-solving skills.
- Ability to manage a project from start to finish.
- Strong relationship-building skills and leadership qualities.
- Training and teaching skills, including 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 with a focus on integration.
- Experience with Medicaid, Medicare, Commercial, and Managed Care.
- Current, unrestricted RN licensure.
- Preferred experience in prior authorization strategies.
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 ensure coordination and communication.
- Assist with monitoring legislative and governmental activities, coordinating integration of clinical services, and identifying opportunities and issues.
- Support data-driven efforts to improve member outcomes and experiences.
- Support and lead readiness activities for new business and programs.
- Develop program documents and operational workflows.
- Engage stakeholders to ensure organizational alignment.
- 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 bonus tied to company and individual performance.
- Comprehensive total rewards package focused on employee well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Director
