UM Operations Strategy & Implementation Lead - UM Focused

Job Summary :

The Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM department. This role will also drive key process changes and identify key gaps and variances across the department.

Essential Functions :

• Utilize process controls to achieve operational excellence in all areas within the department
• Actively work with UM leadership in closing variances of identified risks to compliance
• Utilize process improvement frameworks to drive continuous improvement
• Assess data to identify any misalignment with compliance, regulatory and operational requirements and support process changes that result from any identified opportunities
• Collaborate with analytics, Physical Health and Behavioral Health clinical teams, compliance and regulatory to ensure regulatory content is represented in the data sets and validated
• Assist in implementations of changes through systematic and measurable actions ensuring regulatory, accreditation, and compliance business goals are met
• Assist in the creation of the UM (including Clinical responses) for the NQTL data and narrative submissions
• Proactively build and manage various relationships to improve standardization and interdepartmental collaboration on enterprise goals and initiatives
• Provide Clinical and UM support on parity associated internal compliance workgroups
• Work collaboratively with the appropriate departments to define and utilize outcome measurements, and support a culture of compliance
• Partner as needed with other departments to support in the implementation of process improvement opportunities, new business rules, new products and delegations
• Support change management initiatives that impact the department
• Assist in analysis and recommendations for annual product filings and UM strategy from a parity perspective
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

81,400.00 - $130,200.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly / salary) :

Salary

Organization Level Competencies

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Salary : $81,400 - $130,200