Director of Utilization Management

3 days ago

Boston, Massachusetts, United States Commonwealth Care Alliance Full time
Job Summary

We are seeking a highly skilled and experienced Director of Utilization Management to lead our healthcare operations team. As a key member of our leadership team, you will be responsible for developing and implementing strategies to improve the quality and efficiency of our utilization management processes.

Key Responsibilities
  • Develop and implement utilization management strategies to improve quality and efficiency
  • Lead and manage a team of healthcare professionals to ensure compliance with regulatory requirements and accreditation standards
  • Collaborate with cross-functional teams to develop and implement care management and care delivery processes
  • Ensure integration of utilization management functions with network strategy, vendor relationship management, and claims processing
  • Develop and maintain relationships with providers and vendors to ensure effective utilization of healthcare services
  • Monitor and analyze data to identify trends and opportunities for improvement
  • Develop and implement corrective action plans to address issues and concerns
Requirements
  • 7-10 years of managed care operations experience, including a minimum of 5 years of leadership experience in utilization management or nursing leadership
  • Minimum 3 years of management experience in a health plan environment with responsibility for managing the effective utilization of healthcare services
  • Minimum 5 years of clinical experience in medical or behavioral health care delivery
  • Medicare and Medicaid managed care experience
  • Demonstrated knowledge of federal and state regulations relevant to utilization management
  • Demonstrated knowledge of healthcare industry trends, developments, and issues
Preferred Qualifications
  • Master's degree in Business or Health-related field
  • Bilingual or multilingual
  • Experience with managing clinical services for Medicaid/Medicare patients
What We Offer

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced leader who is passionate about improving healthcare outcomes, we encourage you to apply for this exciting opportunity.

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