Director, Utilization Management(Experienced managed care leader with demonstrated success in oversight and accountability of UM performance and compliance. RN BSN or MSN preferred. PST preferred)

Job Summary :

The Director, Utilization Management leads and manages all functions within medical management and level one case management programs to ensure consistent, efficient delivery of services throughout the healthcare continuum and demonstration of positive outcomes.

Essential Functions :

• Leadership role in transitioning to the "next generation" of Care Management
• Continuous review of business workflows to improve productivity and ensure member and provider satisfaction
• Facilitate and promote problem identification, analysis and resolution
• Expand ability to meet State contract requirements for existing and new populations with proactive processes to ensure success
• Ensure monitoring of regulatory requirements and oversight of all submissions
• Determine benchmarks, goals and outcomes for all programs as well as high cost, volume and risk conditions
• Determine benchmarks, goals and outcomes for staff and implement an accountability system
• Monitor CQI activities in accordance with regulatory requirements and URAC standards
• Develop and coach employees
• Build succession plan for Director and Manager positions
• Foster relationships with hospitals, physicians and community agencies
• Identify "wellness continuum" opportunities and develop successful blending of case, disease and medical management functions
• Identify and report risk management issues for the department and CareSource as a whole
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$132,900.00 - $232,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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