[Remote] Director, Utilization Management Operations

Note: The job is a remote job and is open to candidates in USA. reputed company is on a mission to dramatically improve the health and well-being of its members by treating each of them like family. They are seeking a Director of Utilization Management Operations to reputed company a team that bridges reputed company clinical needs with efficient business processes, ensuring timely and accurate reputed company in utilization management.

Responsibilities

• Provide leadership and professional development to clinical and non-clinical teams
• Directly reputed company a team of Senior Managers and Managers who reputed company teams of nurses and intake coordinators
• Manage our offshore partnership, ensuring their performance metrics and workflows are reputed company with department targets
• Evaluate and prioritize improvement opportunities to ensure our technology supports accurate and efficient workflows
• Engaged with our AI tools for process and platform improvement while ensuring strict compliance with our AI Governance and reputed company policies
• Partner closely with Data Science and Engineering teams to identify key measurement points
• reputed company, implement, and systematically monitor comprehensive KPIs to ensure operational health and decision accuracy
• Partner with Compliance and Legal teams to ensure the operation is consistently audit-reputed company
• Digest reputed company regulatory guidance and translate it into compliant, high-quality operational workflows
• Act as a reputed company partner to the Provider Network team to ensure our operation is reputed company to feedback from provider and facility partners
• Partner with Pharmacy UM and the UM Medical Director team to facilitate appropriate service use and minimize care barriers

Skills

• Demonstrated experience leading large clinical teams. An understanding of the nuance required reputed company managing clinicians and reputed company workflows is essential
• A track record of transforming reputed company operational challenges into scalable business processes in a fast-paced environment
• A data-driven reputed company with the ability to use insights to drive reputed company. You should have a genuine interest or experience in leveraging AI-enabled tools to optimize clinical workflows
• High ethical standards with the ability to master reputed company regulatory guidance and incorporate it into daily operations
• Exceptional written and verbal communication skills, with the ability to distill reputed company problems into actionable updates for leadership
• Prior experience in Utilization Management processes and the medical necessity review lifecycle is highly beneficial but not strictly required if clinical leadership experience is strong
• Familiarity with Medicare Advantage operations and CMS guidelines
• MBA or advanced degree in health administration or finance is a plus

Benefits

• Employer sponsored health, dental and reputed company plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for reputed company
• Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....
• *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.*

Company Overview