Associate Director, Utilization Management – Behavioral Health

DirectorDirectorFull TimeRemoteTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany Site LinkedIn

Location

Massachusetts

Posted

26 days ago

Salary

$113K - $197.7K / year

Bachelor Degree5 yrs expExperience acceptedEnglish

Job Description

• Assist UM leadership in leading and managing all functions within behavioral health management • Collaborate with market and enterprise leaders to support development and knowledge transfer for Behavioral Health UM • Monitor effective use of prior authorizations, policies, and benefits to ensure consistent, effective and efficient delivery to members while meeting regulations and internal financial objectives • Facilitate and promote problem identification, analysis, and resolution • Proactive monitoring of regulatory requirements and meet State contract requirements for existing and new populations • Ensure Behavioral Health UM programs and operational processes are properly developed and aligned to the organization’s strategic goals • Determine benchmarks, goals and outcomes for staff and implement an accountability system • Monitor CQI activities in accordance with regulatory requirements and accreditation standards • In partnership with UM leadership, review available reporting to analyze trends, identify opportunities and ensure alignment with policies & procedures • Develop and coach employees • Build succession plan inclusive of manager and team • Foster relationships with hospitals, physicians and community agencies to improve member and provider satisfaction • Identify and report risk management issues for the department and CareSource as a whole • Perform any other job duties as requested

Job 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) of experience in utilization management in an MCO required; quality improvement and/or project management background preferred
Minimum of three (3) years management experience required
Proficiency in Microsoft Office products including Word, Excel and PowerPoint
Internet research skills preferred
Ability to work independently and within a team environment
Attention to detail
Understanding of predictive modeling process/tools
Customer service oriented.
Current, unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is required
Managed Care, Utilization management Case Management and/or Quality Improvement certification preferred