Utilization Review Care Management Director

Intermountain Health

9d • $60 - $92 • Onsite

About The Position

This leadership role is responsible for providing leadership and administrative oversight to ensure effective coordination of patient services across multidisciplinary teams and throughout the continuum of care. The leader collaborates closely with Medical Staff, Nursing, Clinical Services, and Revenue Cycle leadership to promote high-quality patient care, achieve financial objectives, and support leadership development. This position is operationally responsible for a broad range of care management services, including complex care management, social work, transition planning, behavioral health, and care coordination. These services may be delivered in various settings, including acute care, emergency departments, ambulatory clinics, and home-based environments. Reporting to a member of senior leadership, this position is accountable for designing, implementing, and managing longitudinal care strategies that ensure seamless transitions across care settings. The leader will drive initiatives and partnerships that ensure patients receive the right care, at the right time, from the right provider, in the most appropriate setting, optimizing health outcomes and cost-effectiveness. Travel to locations across the enterprise may be required.

Requirements

• Current Registered Nurse (RN) license or Licensed Clinical Social Worker (LCSW) license in state of practice.
• Bachelor of Science in Nursing (BSN) OR Master of Social Work (MSW) from an accredited institution (degree verification required).
• Care Management Certification within 24 months of hire or promotion.
• Demonstrated management experience in Care Management or related area.
• Demonstrated experience in hospital or ambulatory case management, social work, or related areas requiring knowledge of the current healthcare environment, healthcare regulatory matters, and healthcare reimbursement.
• Demonstrated knowledge and oversight of government regulations, contractual requirements, and NCQA accreditation standards.

Nice To Haves

• If an RN, Master of Science in Nursing (MSN) from an accredited institution must be obtained within four (4) years of hire or promotion.
• Professional experience working in an integrated delivery system that includes a health plan.
• Experience in directing other clinical areas, collaborating with physicians, and developing clinical strategies, implementing operational efforts, and measuring outcomes.
• Experience evaluating technology solutions to support care management functions.
• Experience with developing collaborative relationships with payors to address healthcare needs across the continuum.
• Experience in a role requiring strategic thinking and planning skills and the ability to develop proposals, pilots, and projects from conception to implementation.

Responsibilities

• Oversees strategic planning, day-to-day operations, and standards of care, promoting efficient, fiscally responsible, effective, safe, and compassionate care.
• Accountable for fiscal management, including budget development, cost center analysis, and ongoing monitoring to ensure alignment with organizational goals.
• Models professionalism and fosters a supportive environment, leading workforce planning efforts focused on recruitment, retention, staffing, development, and succession planning.
• Oversees human resource functions including interviewing, hiring, onboarding, training, and performance management, which may include corrective action and termination.
• Facilitates coordinated clinical and non-clinical care in collaboration with interdisciplinary teams and providers to enhance patient outcomes.
• Partners with physicians to achieve clinical, operational, financial, and service excellence.
• Ensures processes and programs support patient satisfaction and service quality goals.
• Builds community relationships and promotes the integration of community resources to enhance the overall patient experience.
• Ensures compliance with regulatory agencies regarding discharge planning, conditions of participation, and care management.

Benefits

• Annual Pay for Performance (AP4P) Plan
• Sign-on bonus
• Relocation assistance
• Generous benefits package covering a wide range of programs to foster a sustainable culture of wellness

What This Job Offers

• Job Type: Full-time
• Career Level: Director