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Director, Utilization Management Behavioral Health

Company: CareSource
Location: Dayton
Posted on: March 16, 2019

Job Description:

Role and Responsibility:* Lead and manage all functions within medical management and level one case management programs to ensure consistent, efficient delivery of services throughout the healthcare continuum and demonstration of positive outcomes* Leadership role in transitioning to the "next generation" of Care Management* Continuous review of business workflows to improve productivity and ensure member and provider satisfaction* Facilitate and promote problem identification, analysis and resolution* Expand ability to meet State contract requirements with proactive processes to ensure success* Ensure monitoring of regulatory requirements and oversight of all submissions* Determine benchmarks, goals and outcomes for all programs as well as high cost, volume and risk conditions* Determine benchmarks, goals and outcomes for staff and implement an accountability system* Monitor CQI activities in accordance with regulatory requirements and URAC standards* Develop and coach employees* Build succession plan for Director and Manager positions* Foster relationships with hospitals, physicians and community agencies* Identify "wellness continuum" opportunities and develop successful blending of case, disease and medical management functions* Identify and report risk management issues for the department and CareSource as a whole* Perform any other job related instructions, as requestedWorking Conditions:* General office environment; may be required to sit/stand for long periods of timeRequirementsEducation / Experience:* Bachelor's degree in nursing or related field required or equivalent years of relevant experience required* Master's degree preferred* Minimum of five (5) years of experience in one of the following: case management, medical management , disease management, quality improvement in a MCO required; quality improvement background preferred* Experience in Behavioral Health managed care programs required* Minimum of five (5) years management experience required* Experience in Disease Management preferredRequired Competencies / Knowledge / Skills:* Proficiency in Microsoft Office products including Word, Excel and PowerPoint* Internet research skills preferred* Leadership experience and skills* 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, case management, medical management and quality improvement* Excellent communication skills, both verbal and written* Management skills including human capital and project management* Ability to work independently and within 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 orientedLicensure / Certification:* Current, unrestricted RN licensure in the state of practice required* Managed Care, Utilization management Case Management and/or Quality Improvement certification preferredApply On-lineSend This Job to a FriendCopyright ? Ultimate Software

Keywords: CareSource, Dayton , Director, Utilization Management Behavioral Health, Healthcare , Dayton, Ohio

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