Senior Director of Utilization Management and Transitional Care

2 days ago


Seattle, Washington, United States ASSOCIATION FOR COMMUNITY AFFILIATED PLANS Full time
About the Role

The Senior Director of Utilization Management and Transitional Care will play a pivotal role in driving the vision and strategy for our integrated medical and behavioral utilization management and transitional care programs.

This leadership position will oversee the comprehensive utilization management and transitional care strategy, ensuring that our programs meet all state, federal, and regulatory requirements.

The ideal candidate will have a strong background in utilization management and a proven track record of leading teams to achieve quality-driven outcomes and meet regulatory requirements.

Key Responsibilities
  • Lead the systematic and comprehensive utilization management program, incorporating intake, clinical review, medical necessity, discharge planning, and post-discharge support.
  • Ensure compliance with State (HCA), Federal (CMS), and NCQA regulatory standards.
  • Develop and implement strategic initiatives to enhance quality-driven outcomes and meet regulatory requirements.
  • Build strong relationships with key stakeholders and collaborate effectively across departments.
  • Oversee key performance indicators and ensure timely reporting to internal committees, external regulators, and leadership.
What We're Looking For
  • A Bachelor's degree in nursing or a relevant field (Master's degree preferred).
  • A current unrestricted RN or ARNP license in the State of Washington.
  • At least ten years of progressive UM or related managed care experience, with five years in a leadership role.
  • Experience with Medicaid, Medicare, and DSNP programs, including knowledge of CMS and NCQA standards.
  • Strong analytical and problem-solving skills, with the ability to drive change through data-driven decision-making.
  • An inclusive leadership style with a transformational spirit, open to innovative ideas and out-of-the-box thinking.
  • Ability to build and maintain effective working relationships across departments and with external stakeholders.
Why You'll Love Working at Association for Community Affiliated Plans
  • Competitive salary range: $170,000 – $200,000 with 15% annual bonus potential.
  • Comprehensive benefits package, including medical, dental, vision, telehealth, flexible spending accounts, and more.
  • Opportunities for professional growth and development in a supportive and dynamic work environment.
  • A commitment to diversity, equity, and inclusion in all aspects of our organization.


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