Associate Director, Health Services - Remote

Overview

The Associate Director, Health Services serves as the strategic leader for utilization management, population health, care coordination and case management, focusing on enhancing clinical capabilities and member care.

In Short

• Lead utilization management and care coordination efforts.
• Develop and implement departmental policies and procedures.
• Ensure compliance with Medicaid and NCQA standards.
• Supervise care management and utilization management teams.
• Collaborate with clinical leadership for compliance and quality assurance.
• Monitor performance metrics for care management activities.
• Facilitate cross-departmental collaboration.
• Participate in audit preparation and response.
• Manage complex technical and operational problems.
• Provide guidance to team members for optimal member outcomes.

Requirements

• Bachelor's degree in nursing, public health, health administration, or related field.
• 3+ years of clinical leadership experience in utilization management.
• 3+ years of care management leadership experience.
• Comprehensive knowledge of Medicaid regulatory requirements.
• Unrestricted RN license in South Carolina preferred.
• Proficient in Microsoft Office applications.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and other opportunities.