Head of Operations Management (m/w/d)

Job Summary:

The Director, Utilization Management Operations assists the UM Department with all open projects and progress towards company and department initiatives including program descriptions, evaluations, policies, procedures, new business requirements, contract compliance and execution, and all related activities
Manages and prioritizes UM and related projects, and ensures timeliness and adherence to completion
Responsible for gathering and prioritization of business requirements for departmental requests including regulatory reporting
Monitors performance across programs to identify improvement opportunities, leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
Supports the ongoing, data-driven approach to improve outcomes and experiences for members
Supports and leads readiness activities for implementation of new business and programs
Develops program documents and operational workflows
Adds services and processes related to the development of new lines of business as required
Bachelor’s Degree or equivalent years of relevant work experience is required
Minimum of five (5) years medical management operations, leadership, program, or management experience is required
Minimum of one (1) year Utilization Management experience preferred
Experience with Medicaid, Medicare, Commercial and Managed Care is preferred
Strong Knowledge of Visio, Microsoft Word, Excel, PowerPoint and Project
Strong organizational, time management, analysis, and problem solving skills
Ability to manage a project from start to finish
Strong relationship building skills and leadership qualities
Training and teaching skills/change agent
Behavioral Health, Case Management, Utilization Management, Integration and Pharmacy
General office environment; Some travel may be required to fulfill the duties of the role
135,600.00 - $237,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. Compensation Type (hourly/salary):
Cultivate Partnerships
Pursue Personal Excellence
Understand the Business