Utilization Management Director

Summary

Join Included Health as their Utilization Management (UM) Director, where you'll lead the strategic vision for the UM service line over the next 2-3 years. You will oversee all UM initiatives and serve as the company's subject matter expert. This role demands strong collaboration, excellent stakeholder management, and a highly organized approach. As the UM leader, you'll represent Included Health externally with clients and partners. You will report to the Senior Director, Clinical Products & Services. The position offers a competitive salary and benefits package.

Requirements

• Have a Bachelor's Degree
• Have a Master's Degree in Nursing, Hospital Administration or related field
• Be a Registered Nurse, in good standing with current state of licensure and with 3 years of experience as inpatient RN
• Have a minimum of 5 years of management experience in a health-related field, along with 3 years of experience in a quality management position
• Have previous quality and workflow management experience
• Possess excellent organizational skills and attention to detail
• Be data-driven and comfortable in using tools to evaluate and optimize the standardization of care across our growing team
• Be able to be agile and balance multiple priorities while maintaining a positive and professional attitude
• Demonstrate professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbal
• Possess strong ambition and internal drive

Responsibilities

• Be accountable for the success of the Included Health UM program
• Manage the UM program with dotted line oversight of the UM RN lead
• Coordinate exceptionally with internal and external resources to develop, build and execute the utilization management program
• Establish and maintain excellent communication and relationships with key cross-functional stakeholders
• Ensure internal and external workflows are efficient and up-to-date
• Partner closely with key stakeholders in Care and Case management (CCM) as well as member care operations to deliver an exceptional member experience in UM operations
• Serve as a final escalation point for workflow questions/clarifications and complex cases
• Focus on continuous improvement, pilot alternative solutions that improve team productivity, workflows, member experience, and efficiency aligning directly with our company values and goals
• Design and implement a quality review process for UM both internally and externally

Preferred Qualifications

• Have project management experience
• Have previous Case/Care Management experience

Benefits

• Equity
• Benefits