Director, Clinical Operations
6 days ago
About Evolent Health
Evolent Health is a healthcare company that partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions.
We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
What We're Looking For
We're seeking a Director, Utilization Management to join our team. As a key member of our clinical operations team, you'll work with managers, front-line clinical teams, and matrix partners to ensure delivery on clinical excellence, performance guarantees, and efficiencies for our members, providers, and customers.
Key Responsibilities
- Lead utilization management activities, including design, implementation, and oversight of operations.
- Monitor all activities related to clinical review and develop processes where indicated.
- Partner with leadership to mentor staff and develop goals, objectives, and define major roles.
- Responsible for achieving targeted utilization management results established by the department and/or client.
- Develop and adopt best practice methodologies and training programs for utilization management tools and techniques.
- Provide recommendations on staffing plans and assure adequate allocation of resources for UM functions.
- Collaborate with IT and Analytics teams for the development of required utilization management monitoring, initiatives, patient engagement, and other outcomes initiatives.
- Collaborate with other functional areas that interface with the utilization management department.
- Provide appropriate and timely management of complex clinical issues.
- Mentor and support ongoing training and development of staff.
- Promote a positive work environment by providing timely, specific, and constructive performance feedback.
Requirements
- Active clinical license such as Registered Nurse (RN), Physical/Occupational/Speech/Radiation Therapist, or Chiro, Pharmacist.
- Working knowledge of utilization management activities such as prior authorization, concurrent review, intake, appeals, and grievances.
- Five (5) to seven (7) years of progressive experience in utilization management.
- Bachelor's Degree in Nursing or related healthcare field (with Bachelor's/Master's Degree in Business Administration/Hospital Administration/Public Health).
Technical Requirements
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
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