Job

Senior Director of Utilization Management (Medicare Advantage)

Location Remote, TX 1
Date Posted November 11, 2020
Job ID 6970
Employment Type Direct Hire
Scion Staffing, Inc. (www.scionstaffing.com), a full-service national staffing firm, has been engaged to conduct a search for a Senior Director of Utilization Management for our client, a rapidly growing, innovative, and energizing organization with a unique approach to managing care delivery! This is an enticing career growth opportunity for a skilled utilization management professional looking for an inspiring organization to innovate and progress within!

This is an exciting opportunity for you to serve in a mission-critical role with a cutting edge, fast-paced, and rapidly growing company!

In this search, we are specifically targeting candidates who can develop processes and workflows from scratch or re-design with their own vision! Are you ready for this type of challenge?

We are also looking at hiring a candidate with a depth of first-hand knowledge of Medicare Advantage regulations, a very strong understanding of MA compliance as related to the UM process. Do you have a working knowledge of Health Plan UM, specifically Medicare Advantage UM experience i.e. Medicare Plan utilization management compliance, policy and process, notification requirements, LCDs, Medicare payment policies, and more?

While we fully recognize the incredible talent in all candidates based within the hospital setting, our client specifically seeks a high-level candidate with managed care experience. Do you have leadership level managed care work experience?

If you are looking to serve in an important and inspiring role and step into a real opportunity to advance your career into a Head of Health/Clinical Services position, please apply now!

What you’ll be doing in this exciting role:
This unique role requires a combination of skills grounded in nurse supervision in utilization management to ensure delivery of high quality and cost-effective services! Our client’s clinical philosophy, programs, policies and procedures, strategic plan, and a focus on best practices are at the center of this role.

- Supervising nurses to ensure the organization is delivering high quality and cost-effective utilization management and case management services
- Managing all UM activities including staff assignments, authorization timeliness, discharge planning
- Ensuring that members are getting the right healthcare at the right place and in the most cost-effective manner
- Applying clinical philosophy, programs, policies and procedures to communicate the strategic plan to the staff that works with the organization’s members
- Focusing on key priorities and best practices while providing innovative ideas to improve outcomes
- Implementing Case Coordination activities; assessing and developing care plans
- Monitoring quality with a keen focus on medical necessity guidelines and discharge planning opportunities to lower levels of care
- Enforcing adherence to policies and procedures
- Communicating and educating staff on expected outcomes and requirements
- Hiring and leading performance counseling for all nursing and non- clinical staff with relation to utilization management and case management activity
- Assessing the developmental needs of the staff and action items to improve performance and focus on interventions for improvement
- Monitoring all member and provider letters including denial, get in touch and case management correspondences
- Assisting with referrals for potential quality concerns to the Quality Department
- Providing suitable and timely responses to clients and account managers regarding UM and CM questions
- Maintaining working knowledge and communication of legislature, insurance changes, CMS and State regulations that may affect utilization management policy, trends, and standards
- Monitoring utilization reports assuring compliance with reporting and turnaround times
- Coordinating an interdisciplinary approach to support continuity of care and managing the Case Management process assisting in the development of case management programs
- Developing and implementing new systems, policies/procedures, and workflows

What you can bring to this opportunity and organization:
- A very deep-rooted passion for and commitment to innovation, growth and inspiring work within focused in revolutionizing the long-term healthcare ecosystem
- 5+ years of clinical experience as RN plus medical-surgical experience, RN with active unrestricted Nursing license
- 5+ years managed care Utilization Management experience, health plan utilization management, facility concurrent review discharge planning, and case management; Medicare Advantage experience is a plus!
-  3+ years supervisory experience
- Excellent computer skills, MS Excel intermediate proficiency (pivot tables, etc.) and ability to learn new systems required

Compensation & Benefits:
The ability to work for an organization with a phenomenal business model, innovative team-oriented work environment and a competitive market aligned salary of up to $165,000 plus robust benefits package including: PTO, Paid Holidays, Floating Holidays, Medical/Dental/Vision Insurance benefits, Health Savings Account, Long & Short-Term Disability, Life Insurance, a 401K Plan!

How to Apply:
For immediate consideration, please submit your resume and cover letter here: www.scionstaffing.com/job/6970

About our search firm:
Scion Staffing is an award-winning staffing firm. Over the past few years, our firm has had the pleasure of successfully assisting hundreds of local employers. No matter the requisition or size, our track record and recruitment process has made us one of the top recruitment firms on the West Coast. Additional information about our firm and success can also be found online at www.scionnonprofitstaffing.com, or in the 2010-2020 Business Times list of top staffing firms.

Scion Staffing is an equal opportunity employer and service provider committed to not discriminate on the basis of race, religion, gender, gender identity, national origin, citizenship status, sexual orientation, disability, political affiliation or belief. We are committed to the principals of Equal Opportunity Employment and are dedicated to making employment decisions based on merit and value, for ourselves, our client companies, and for the candidates we represent.

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