Director of Utilization Management

2 weeks ago

Oklahoma City, Oklahoma, United States Sun Life Full time
About the Role

We are seeking a highly skilled and experienced Director of Utilization Management to join our team at Sun Life. As a key member of our healthcare management team, you will be responsible for designing, implementing, and administering utilization management programs that improve efficiency, quality, and accuracy.

Key Responsibilities
  • Develop and implement utilization management models that optimize staff and external partner productivity and value.
  • Contribute to business unit objectives through the recommendation, development, and implementation of utilization management strategies.
  • Work with internal departments to implement strategies and programs to proactively manage dental utilization costs within each market.
  • Develop and implement process and program redesigns to improve efficiency and ensure budgetary and performance goals are met.
  • Manage department budget and oversee projects that improve efficiency and ensure resultant budgetary and performance goals are measured and achieved.
  • Represent the company to external stakeholders, including provider organizations, customers, advocacy groups, and government entities.
  • Manage relationships and operations with external partners/vendors that provide services as part of the UM program.
  • Oversee and direct utilization management department personnel and metrics to ensure compliance with business unit objectives.
  • Meet applicable regulatory and compliance standards and accreditation requirements by maintaining a continuous quality improvement program.
Requirements
  • 10+ years of management/supervisory experience in healthcare management or a related field.
  • 5+ years of clinical experience in the dental industry (preferred).
  • Research and analytic skills or ability to oversee, understand, and articulate the results of research and analysis.
  • Knowledge and understanding of regulatory language.
  • Excellent oral and written communication skills.
  • Experience managing cross-functional projects.
  • Knowledge of managed care health plans operations and HIPAA guidelines.
  • Intermediate computer skills.
About Sun Life

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. We strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

We are committed to making life brighter for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit https://www.sunlife.com/us/en/ to learn more.

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