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Associate Director, Utilization Management – Behavioral Health
Location
Massachusetts
Posted
122 days ago
Salary
$113K - $197.7K / year
Seniority
Senior
Job Description
Associate Director, Utilization Management – Behavioral Health
CareSource
• 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
Benefits
- Comprehensive total rewards package
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