The WelbeHealth PACE program helps seniors stay in their homes and communities by providing all-inclusive medical care and community-based services. We serve our most vulnerable seniors with better quality and compassion in a value-based model.
The Director, Utilization Management (UM) is accountable for developing key utilization processes, protocols, policies, and the implementation and oversight of such across multiple teams and functional areas. The ideal candidate for this role has an advanced understanding of utilization in a managed care setting, navigates between detail-orientation and executive communications with ease, and is galvanized by the opportunity to create structure and innovation in a high growth, value-based care organization.
Essential Job Duties:
· Champion the right priorities, strategies, and practices to create optimal payer-provider alignment in a value-based care model
· Own and oversee end-to-end authorization process, including near term system migration and overhaul of current infrastructure
· Create payment and determination protocols in alignment with desired utilization outcomes, applicable regulatory requirements, and clinical quality as a compass
· Document policies required to execute desired outcomes
· Train and engage cross-functional leadership on utilization operating procedures and how to best support elaborate patient needs
· Build scalable UM infrastructure and team to support census growth and centralized payer/contact center function
· Develop short and long term departmental KPI targets and provide objective evidence of progress towards achieving desired results
Job Requirements:
· Bachelor’s degree required, preferably in nursing or the healthcare field; master’s degree in nursing, business administration/hospital administration/public health strongly preferred
· Graduate of an Accredited School of Nursing: Unencumbered Registered Nurse (RN) License, (BSN) preferred
· Minimum of five (5) years of operations and UM experience in a managed care/payer setting
· Minimum of three (3) years of experience managing high performing teams
· Sophisticated knowledge of clinical operations in managed care, key value-based care outcomes, and provider network, claims, call center operations
Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
· 401k + employer match
· Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
· Work life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
· And additional benefits
Salary/Wage base range for this role is $159,939 - $191,926 / year + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
Compensation
$159,939—$191,926 USD
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected]
What We Do
WelbeHealth provides full-service care to help seniors age well at home and in their community, often at no cost. Services include medical, coordination, home care, dental, transport, physical therapy, prescriptions, social activities and meals.
Founded by a seasoned group of physician entrepreneurs, our leadership team hails from leading payer and provider organizations such as GoHealth Urgent Care, BAYADA Home Health, AirStrip Technologies, Evolent Health, and On Lok.
With funding from leading venture investors, we're looking for team members who are inspired to help us deliver on our mission of unlocking the full potential of the most vulnerable seniors. Our colleagues are energized by working in diverse groups toward our shared purpose, are eager to drive groundbreaking innovations, and have the courage to care for our participants with empathy and love.
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