Clinical Leadership Director

1 week ago


Baltimore, Maryland, United States CareFirst Full time
About the Role

CareFirst is seeking an experienced Clinical Leadership Director to lead our Utilization Management team. As a key member of our Core Clinical Operations Admin department, you will be responsible for providing strategic leadership and direction to the team, ensuring the effective design, implementation, and outcomes of utilization management strategies.

Key Responsibilities
  • Strategic Leadership: Provide vision and direction to the Utilization Management team, ensuring alignment with CareFirst's business strategy and goals.
  • Team Management: Recruit, retain, and develop a high-performing team, ensuring they have the necessary skills and competencies to excel in their roles.
  • Performance Metrics: Establish and monitor performance metrics to ensure the needs and requirements of our members, providers, and regulators are met.
  • Utilization Review: Oversee the utilization review process, ensuring compliance with policies, accreditation standards, and regulatory requirements.
  • Collaboration: Work closely with leadership, members, providers, vendors, and other strategic business partners to ensure effective communication and collaboration.
Requirements
  • Education: Bachelor's Degree in Nursing or equivalent experience.
  • Licenses/Certifications: Registered Nurse (RN) licensure and/or compact state licensure.
  • Experience: 8 years' experience in a clinical and utilization review role, with 3 years of management experience.
  • Preferred Qualifications: Knowledge of Medicare Advantage, Medicaid Managed Care, and utilization management processes.
What We Offer

CareFirst offers a comprehensive benefits package, various incentive programs, and 401k contribution programs. We are an Equal Opportunity employer and welcome applications from diverse candidates.


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