Utilization Management Director - Remote

Overview

The Utilization Management Director at Included Health is responsible for setting the strategic vision for the UM service line, overseeing all UM initiatives, and serving as the subject matter expert in utilization management. This role requires strong collaboration, stakeholder relationship management, and organizational skills.

In Short

• Accountable for the success of the Included Health UM program.
• Manage the UM program with oversight of the UM RN lead.
• Coordinate with internal and external resources to execute the UM program.
• Maintain communication with key cross-functional stakeholders.
• Ensure workflows are efficient and up-to-date.
• Partner with stakeholders in Care and Case management to enhance member experience.
• Serve as a final escalation point for workflow questions.
• Focus on continuous improvement and productivity enhancements.
• Design and implement a quality review process for UM.
• Responsibilities may evolve based on program needs.

Requirements

• Bachelor's Degree required.
• Master's Degree in Nursing, Hospital Administration, or related field required.
• Registered Nurse with 3 years of inpatient RN experience.
• Minimum 5 years of management experience in a health-related field.
• 3 years of experience in a quality management position.
• Excellent organizational skills and attention to detail.
• Data-driven and comfortable with evaluation tools.
• Able to balance multiple priorities with a professional attitude.
• Effective communication skills, both verbal and written.
• Strong ambition and internal drive.

Benefits

• Opportunity to lead and innovate in the healthcare sector.
• Collaborative work environment.
• Engagement with diverse stakeholders.
• Professional growth and development opportunities.
• Flexibility in managing work responsibilities.