Director, Utilization Management at VillageMD

| Houston, TX
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Join VillageMD as a Director, Utilization Management in Houston, TX 

Join the frontlines of today's healthcare transformation

Why VillageMD?

At VillageMD, we're looking for an Director, Utilization Management to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

Could this be you?

The Director, Utilization Management (UM) will be the leader in charge of building and implementing UM operations to support VillageMD’s full risk Medicare Advantage contracts in our Houston market. This is a key position to support VillageMD’s strategy for improving the cost and quality of care for the Medicare populations it serves. 

Integral to our team, you will leverage your expertise in UM operations including building an experienced clinical team to perform concurrent review and oversee the pre-service and post-service authorization processes. You’ll work in collaboration with our national head of Delegated Services to adopt best practice methodologies and create training programs for UM tools and techniques to manage a successful transition to a delegated services model across multiple contracts and geographies. You’ll need to demonstrate a passion for building and leading teams as you’ll be responsible for identifying and training the resources necessary to support the execution of our UM model.

How you can make a difference

  • Building a Utilization Management team with responsibility for hiring and training staff, developing business plans, and accountability for creating and achieving financial and operating targets
  • Accountability for the relationships and activities with payor partners necessary to implement and conduct a highly effective Utilization Management  program
  • Establishing targeted Utilization Management KPIs and achieving and communicating results through regular reporting
  • Providing recommendations on staffing plans and assuring adequate allocation of resources for Utilization Management functions while coordinating needs with clinical leaders across markets
  • Collaborating with technology and analytics teams to develop required Utilization Management  monitoring, patient engagement, and other outcomes initiatives
  • Providing analysis and reporting of significant utilization trends, patterns, and impact to resources
  • Ensuring compliance with CMS and payors’ contractual requirements
  • Collaboration with team for targeting, readiness and implementation of future delegations
  • Routine internal auditing to meet compliance regulations

Skills for success

  • You have high emotional intelligence, the ability to forge meaningful relationships, and can successfully navigate diverse stakeholder groups
  • You are skilled at influencing others to achieve results and can pivot between a leadership and support role depending on situation and need 
  • You are accomplished at distilling complex, technical information to stakeholders at an operational level to effect change
  • Experience performing under pressure with a strong sense of urgency, attention to detail, and a commitment to doing what you say you will do
  • You are solution-oriented and have a passion for being hands-on in problem-solving and execution
  • You are self-starting and maintain a high sense of urgency and accountability in delivering measurable results in line with agreed upon timeframes

Experience to drive change

  • Bachelor’s degree required; master’s degree and RN/Advanced Practice Provider preferred with a minimum of 5 years of leadership experience
  • Expertise in health care cost analysis, drivers of medical trends, and quality metrics
  • In depth knowledge of medical necessity criteria software (e.g. NCD/LCD/Interqual/MCG)
  • Leadership experience within the Utilization Management department of a health plan or delegated provider entity
  • Demonstrated experience collaborating with physicians to improve utilization of effective and appropriate services
  • Experience with medical necessity appeals processes and procedures
  • Proven ability to identify, leverage, and rapidly rollout initiatives and can successfully lead through technical, political, and cultural barriers to change
  • You have a keen focus on results, and can navigate within ambiguity while maintaining a high-level of humility
  • Experience with implementation of payors for delegation, organized management of payor criteria, audits and requirements for delegation
  • Managing Payor Relationships and managing Corrective Actions and Root Cause to prevent future occurrences

How you will thrive:

In addition to competitive salaries, a 401k program with company match, and a valuable health benefits package, Village Medical offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on Village Medical products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique Village Medical culture – how inclusion and diversity make the difference

At Village Medical, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Village Medical are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Explore your future with Village Medical today.

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Technology we use

  • Engineering
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • RLanguages
    • SqlLanguages
    • SwiftLanguages
    • ReactLibraries
    • FlaskFrameworks
    • Node.jsFrameworks
    • Microsoft SQL ServerDatabases
    • Neo4jDatabases
    • PostgreSQLDatabases
    • RedisDatabases
    • TeradataDatabases

An Insider's view of VillageMD

What's the biggest problem your team is solving?

Aggregating disparate sets into one consumable interface is difficult. We constantly think about how to solve it faster and better while keeping it flexible and scalable.

Mario

Principal Software Engineer

What makes someone successful on your team?

It’s an individual’s willingness to get into the details, fully understand the current path to delivery, and think critically about the problems that face providers today that will make them successful at VillageMD.

Dave

Director, Product Development

What’s the vibe like in the office?

The office vibe is centered on holding our work to high standards while maintaining an environment focused on fun and collaboration. My coworkers and I will often be working on completely unrelated projects, but when we hit a roadblock we step back and ask each other for feedback and help. That’s usually when we find the best solutions.

Emily

Healthcare Informatics Analyst

What are VillageMD Perks + Benefits

VillageMD Benefits Overview

We offer competitive bonus, great benefits, generous PTO, strong parental leave policy, and 401k with a match. We are conveniently located near Metra and L trains, and offer commuter benefits. We offer schedule flexibility and work from home options. And, last but certainly not least: loads of snacks and fresh ground whole bean coffee!

Culture
Volunteer in local community
Partners with Nonprofits
Eat lunch together
Intracompany committees
Daily sync
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Highly diverse management team
Unconscious bias training
Diversity manifesto
Mean gender pay gap below 10%
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
401(K) Matching
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Generous PTO
Paid Volunteer Time
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Company Outings
Stocked Kitchen
Happy Hours
Recreational Clubs
Relocation Assistance
Professional Development Benefits
Job Training & Conferences
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Customized development tracks

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