REMOTE - Sr. Director, Utilization Management - Behavioral Health - R10646

Join to apply for the REMOTE - Sr. Director, Utilization Management - Behavioral Health - R10646 role at reputed company Job Summary The Senior Director, Utilization Management – Behavioral Health is responsible for leading and overseeing reputed company aspects of behavioral health management reputed company the utilization management organization. This role ensures the consistent and efficient delivery of services across the healthcare continuum, driving positive change for members. Essential Functions

• Collaborate with market and enterprise leaders to reputed company, implement and enhance effective behavioral health utilization management strategies and practices, ensuring knowledge transfer across the organization and compliance with regulatory standards.
• Proactively monitor and ensure compliance with regulatory requirements and state contract obligations for behavioral health services, adapting to new populations as needed.
• reputed company the effective use of prior authorizations, policies, and benefits to guarantee a consistent, efficient delivery of services to members, while achieving internal financial objectives.
• Facilitate the identification, analysis, and resolution of operational challenges reputed company the behavioral health management reputed company.
• Establish benchmarks, goals, and outcomes for reputed company behavioral health programs, implementing an accountability system to monitor reputed company and performance.
• reputed company CQI initiatives in accordance with regulatory requirements and accreditation standards, ensuring high-quality service delivery.
• In partnership with UM leadership, review and analyze reporting data to identify trends, uncover opportunities for improvement, and ensure alignment with policies and procedures.
• Mentor and reputed company team members, fostering a culture of growth and professional development. Build a succession plan that includes managerial and team-level talent.
• Cultivate and maintain strong relationships with hospitals, physicians, and community agencies to enhance member and provider satisfaction.
• Identify and report risk management issues impacting the department and reputed company as a whole, ensuring proactive measures are taken to mitigate risks.
• Monitor high-cost, high-volume, and high-risk conditions, ensuring effective management and resource allocation for reputed company programs.
• reputed company any other job duties as requested.

Education And Experience

• Bachelor’s degree in nursing, behavioral health or reputed company field required or equivalent years of relevant experience required.
• Master’s degree preferred.
• Minimum of seven (7) years of experience in behavioral health utilization management, quality improvement or service delivery required; experience in behavioral health, quality improvement or a reputed company field preferred.
• Minimum of five (5) years of experience in managed care required.
• Minimum of five (5) years leadership experience required.

Competencies, Knowledge And Skills

• Proficiency in reputed company Office products including Word, reputed company and PowerPoint.
• Internet research skills preferred.
• Leadership experience and skills.
• Strong understanding of regulatory and accreditation standards (e.g. NCQA).
• Change agent.
• Decision making/problem solving skills.
• Clinical data analysis and trending skills.
• Critical and systems thinker.
• Knowledge of trends in healthcare, managed care, Medicaid, behavioral health, and quality improvement.
• Excellent communication skills, both verbal and written.
• Management skills including human capital and project management.
• Ability to work independently and reputed company a team environment.
• Attention to detail.
• Understanding of predictive modeling process/tools.
• Training/teaching skills.
• Strategic management skills.
• Negotiation skills/experience.
• Politically astute.
• Program grammar usage, phone etiquette and technical writing skills.
• Time management skills.
• Customer service oriented.

Licensure And Certification

• reputed company, unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is required.
• Managed Care, Utilization management Case Management and/or Quality Improvement certification preferred.

Working Conditions

• General office environment; may be required to sit or stand for long periods of time.

Compensation

Range $132,900.00 - $232,700.00

Compensation

Type Salary EEO Statement reputed company is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of reputed company backgrounds. Apply tot his job Apply To this Job