Director, Utilization Management – Experienced Managed Care Leader
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $132,900 - $232,700 per year
Job Level
Senior
About the role
- Lead and manage functions within medical management and level one case management programs
- Ensure consistent, efficient delivery of services throughout the healthcare continuum
- Facilitate and promote problem identification, analysis and resolution
- Ensure monitoring of regulatory requirements and oversight of all submissions
- Determine benchmarks, goals and outcomes for all programs as well as conditions
- Develop and coach employees
- Foster relationships with hospitals, physicians and community agencies
- Identify and report risk management issues for the department and CareSource as a whole
Requirements
- Bachelor’s degree in nursing or related field required or equivalent years of relevant experience required
- Master’s degree preferred
- Minimum of five (5) years of experience in case management, medical management, disease management, quality improvement in a MCO required; quality improvement background preferred
- Minimum of five (5) years management experience required
- Experience in Disease Management preferred
- Proficiency in Microsoft Office products including Word, Excel and PowerPoint
- Internet research skills preferred
- Knowledge of trends in healthcare, managed care, Medicaid, case management, medical management and quality improvement
- Licensure as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is required.
Benefits
- Comprehensive total rewards package
- Bonus tied to company and individual performance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementmedical managementdisease managementquality improvementregulatory compliancerisk managementbenchmarkingcoaching
Soft skills
leadershipproblem identificationanalysisresolutionrelationship building
Certifications
Registered Nurse (RN)Licensed Social Worker (LSW)PsychologistProfessional Clinical Counselor (PCC)