Utilization Management Director (CCM)

Responsibilities

• Accountable for the success of the Included Health UM program
• Exceptional coordination with internal and external resources to develop, build and execute the utilization management program
• Establishing and maintaining excellent communication and relationships with key cross-functional stakeholders
• Ensuring internal and external workflows are efficient and up-to-date
• Partnering closely with key stakeholders in Care and Case management (CCM) as well as member care operations to deliver an exceptional member experience in UM operations
• Serving as a final escalation point for workflow questions/clarifications and complex cases
• Displaying focus towards continuous improvement, pilots alternative solutions that improve team productivity, workflows, member experience, and efficiency aligning directly with our company values and goals
• Designing and implementing a quality review process for UM both internally and externally
• Responsibilities may shift over time depending on CCM and/or UM program needs
• Able to work Monday-Friday 8AM to 5PM local time

Basic Qualifications

• Bachelor's Degree required
• Master's Degree in Nursing, Hospital Administration or related field required
• Registered Nurse, in good standing with current state of licensure and with 3 years of experience as inpatient RN
• A minimum of 5 years of management experience in a health-related field, along with 3 years of experience in a quality management position
• Previous quality and workflow management experience required
• Excellent organizational skills and attention to detail required
• Data-driven and comfort in using tools to evaluate and optimize the standardization of care across our growing team
• Ability to be agile and balance multiple priorities while maintaining positive and professional attitude
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbalStrong ambition and internal drive is essential to this position
• Strong ambition and internal drive is essential to this position

Preferred Qualifications

• Project management experience preferred
• Previous Case/Care Management experience a bonus

Physical Requirements

• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner.
• This position requires frequent communication with patients and physicians; must be able to exchange accurate information during these patient encounters
• Occasional overnight business travel
• The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. FInally, this job description is not intended in any way to create a contract of employment.