Job description
Overview:
Responsibilities:
This job is for you if:
What we offer:
#IDCC
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.
The Director of Utilization Management for the Post- Acute Care (PAC) Program provides leadership and oversight of clinical and utilization management (UM) activities for programs in accordance with company policies and procedures. They work with the CareCentrix operations management team to develop, implement and manage effective UM initiatives designed to position CareCentrix as an industry leader for excellent clinical outcomes by obtaining optimal financial results for CareCentrix and their customers.
This person supports and oversees Utilization Management activities to assure positive outcomes and that expectations are exceeded. They also assure that UM activities are compliant with regulatory and accreditation agency standards and client specific requirements. Working with Medical Directors, Product, Account Management, Clinical Management, Client Services and Health Plans for development of clinical and UM program initiatives. They find and implement best practices for utilization and authorization management.
This Director assists with the development of reporting strategies and implements plans to ensure appropriate staff training for all clinical initiatives and monitors outcomes/performance.
Responsibilities:
In this job you will:
- Support and oversee Utilization Management activities to assure positive outcomes and that expectations are exceeded.
- Assure that UM activities are compliant with regulatory and accreditation agency standards and client specific requirements.
- Collaborate with Medical Directors, Product, Customer Service Center (CSC), Account Management, Clinical Management, Client Services and Health Plans in the development of clinical and UM program initiatives.
- Work with CCX senior leadership Clinical Management to develop, direct and implement best practices for utilization and authorization management. Set priorities and goals ensuring utilization performance, compliance and quality standards are met.
- Assist with the development of reporting strategies and implements plans to ensure all outcomes are within stated objectives.
- Ensure appropriate staff training for all new clinical initiatives and monitors outcomes/performance.
- Collaborate with account management, client services and network management to provide education and training to referral sources and providers.
- Direct and implement performance improvement activities to achieve desired goals when necessary.
- Ensure that information is documented/identified enabling the collection and root cause analysis of data to identify opportunities for improvement related to clinical programs.
- Participate in educating associates, management, customers, payers and physicians in best practices and protocols of care that drive both excellent clinical performance as well as optimizing financial results.
- Be the primary point of contact for internal and external audits of UM activities and outcomes.
- Participate in client meetings (JOCs) and provider/market meetings as the senior UM leader.
- Participate in the UM management team as a leader in the organization.
- Encourage and foster an environment of teamwork, communication, collaboration and readiness for change. Sets an example for excellence, professionalism, accountability, innovation, compassion, integrity, and honesty.
- Perform interviews, select, manage and develop new and existing associates to develop a high-performing team with opportunities for growth in the organization.
- Participate and is timely and compliant with the performance review and management process.
- Conduct regular team meetings and meetings with direct reports.
- Administer CareCentrix employee terminations, ensures appropriate paperwork is processed, conducts exit interviews, and monitors/tracks reasons for termination.
- Participate in special projects and performs other duties to make the operation successful.
This job is for you if:
- You possess excellent communication (verbal/written), organizational and interpersonal skills.
- You can manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
You should get in touch if:
- You hold a Bachelor or Master’s degree in Healthcare field.
- You have an active RN licensure required with a minimum of 8 years of clinical experience. Licensed professionals are required to possess a current license from their home state without restrictions.
- You possess a wide-range knowledge and experience with utilization management and accrediting agency standards. Inclusive of industry standard guidelines such as Interqual, MCG and CMS.
- You hold an advanced education which is highly desired and have additional training in the applicable clinical field.
- You have experience with program development (desired)
- You possess experience with data analysis and the design and use of clinical measurement systems
- Yu have excellent verbal/written communication and presentation skills also required
What we offer:
- Salary Range: $100000 - $150000 / year plus Corporate Bonus Incentive
- Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
- Bonus Incentives
- Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
- Advancement opportunities, professional skills training, and tuition Reimbursement
- Great culture with a sense of community.
CareCentrix maintains a drug-free workplace.
#IDCC
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.
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