Healthy Connections Director - Care Management

Intermountain Health • Murray, UT

2d • $59 - $90

About The Position

Select Health is a community health plan serving more than 1 million members. Select Health’s lines of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans. This leader is responsible for the development, implementation, evaluation, and operational management of care management programs for all lines of business that Select Health provides. The position requires an understanding of care management and utilization management industry benchmarks, best practices and regulatory environment for the line of business function. This position leads a team of caregivers and strategy related to care management at the health plan. Utah residency or relocation is preferred; consideration may be given to candidates in other Intermountain or Select Health service areas, such as Idaho, Nevada, or Colorado. Please note that a video interview through Microsoft Teams will be required as well as onsite interviews and meetings Essential Functions Supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey. Oversees program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the department leader in scaling care management and utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way. Ensures Select Health offers competitive programs, monitors medical expense trends for the product line and works with senior leadership to evaluate or add programs to impact trends. Uses a data-driven approach to assess utilization management and care management operations and make program recommendations. For Interdisciplinary Care Management, develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery. Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of Select Health.

Requirements

• Bachelor's or master’s degree in clinical specialty, such as Nurse, LCSW, Nurse Practitioner, Physician's Assistant, Physical or Occupational Therapy. Education is verified.
• Current associated clinical license in state of Utah.
• Experience working in a managed care environment and have familiarity with the regulatory environment pertinent to the Line of Business (LOB) they will oversee (e.g. NCQA, CMS).
• Three years of clinical experience, preferably in a variety of settings.
• Previous leadership or management experience in a managed care environment including organizational and program development skills requiring demonstrated knowledge of care management, utilization management and insurance industry.
• Experience with financial reporting and analysis, preferably in a managed care setting.
• Demonstrated problem-solving ability.
• Demonstrated excellent verbal, written and interpersonal communication skills.
• Demonstrated public speaking and presentation skills.
• Demonstrated Experience Leading a team
• Leadership
• Communication
• Health plan functions
• Utilization review
• Care management
• Performance management
• Change management

Nice To Haves

• Three years of HMO care / utilization management experience.

Responsibilities

• Supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey.
• Oversees program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the department leader in scaling care management and utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way.
• Ensures Select Health offers competitive programs, monitors medical expense trends for the product line and works with senior leadership to evaluate or add programs to impact trends.
• Uses a data-driven approach to assess utilization management and care management operations and make program recommendations.
• For Interdisciplinary Care Management, develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery.
• Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of Select Health.

Benefits

• In addition to the annual salary, to show our commitment to you and assist with your transition,, we may offer a sign-on and relocation bonus when applicable.
• With this position, you are eligible to participate in the Annual Pay for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity.
• The AP4P award opportunities are calculated as a percentage of your base salary.
• Awards are paid out based on attainment of selected Board-approved goals.
• Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution.
• The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates.
• Caregivers are eligible to participate in PEAK on day 1 of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 11-50 employees