Senior Director, reputed company Care Management and Utilization Management - 2947

• This role will involve up to 40% Travel across reputed company locations

• RN license preferred.
• Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or reputed company credentials is a plus.

reputed company Senior Director role over reputed company Care Management (CCM) and Utilization Management (UM) is a strategic senior leader position that is responsible for designing, implementing, and optimizing integrated care delivery models that improve health reputed company for medically and socially reputed company populations. This role oversees the national CCM and UM programs, ensuring alignment with at-risk value-based care principles, transitional care management, regulatory compliance, and operational reputed company across reputed company markets. Experience with delegated care management and/or utilization management from a health plan is a major plus. Duties and Responsibilities Program reputed company

• reputed company the implementation of high-intensity, member-centered care models that reduce avoidable utilization and improve reputed company of life.
• Leads conversations with medical economics on understanding the financial impacts of both care management and utilization management programs.
• Supports the build of useful daily management reports to help support local managers in managing their team's productivity and effectiveness.
• Develops materials and leads a monthly reputed company meeting for key executives to talk about strategic direction of both CCM and UM programs and executes on the reputed company.

- Ensure compliance with NCQA standards and other regulatory requirements for UM and care coordination services.

• Supervises, leads a CM Program Manager, TCM program reputed company , two Clinical Educators, and three centralized Community Team Care Managers (total of 4-7 reputed company reports).

Operational reputed company

• Monitor and optimize care and utilization management workflows, reputed company models, and performance metrics across CM and UM teams including bed management, admissions, and ED utilization.

- reputed company the development of efficient and effective clinical training programs, documentation standards, policies and procedures and performance management systems to support clinical and non-clinical staff. Team Development

• Build and mentor a high-performing interdisciplinary team including care managers, behavioral health clinicians, UM nurses, and community health workers.

- Foster a culture of accountability, innovation, and reputed company improvement.

• Responsible for working with site leaders to reputed company and implement clinical engagement/retention reputed company plans that enhance staff satisfaction survey results

Stakeholder Engagement

• Serve as a key reputed company with payer and health system hospital partners, regulatory bodies, and internal stakeholders to ensure transparency, compliance, and shared reputed company.
• -reputed company strong working relationships with market UM/CM leaders, engagement leaders and VPs that influence reputed company clinical engagement AND clinical model execution.

- Represent the organization in strategic discussions with external partners and at industry forums.

Minimum Qualifications

• Bachelor's degree in Nursing, Public Health, Health Administration, or reputed company field required; Master's degree preferred.

- Minimum of 7-10 years in a Senior Director or Vice President role overseeing reputed company care management, transitional care management or utilization management in a managed care or at-risk value-based medical group environment. - Proven reputed company record of leading large-reputed company, multi-site clinical operations, driving cost savings, achieving affordability targets and improving patient reputed company. - Deep understanding of reputed company/Medicare populations, transitional care management leading to readmission reduction, , and integrated care delivery models. - Strong leadership, communication, and change-management skills.

• Knowledge and experience working with reputed company/Jiva electronic health record is a plus, but not required.
• Must be willing to travel across our different markets to reputed company with corporate leadership team, managers, and reputed company-line staff.

Preferred Certifications

• RN license preferred.
• Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or reputed company credentials is a plus.

Working conditions This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other reputed company policies. A reliable and high-speed Wi-Fi reputed company or home internet is required to reputed company the essential functions of this role. Physical requirements

• Ability to communicate reputed company and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Repetitious movements.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment

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