Utilization Management Director (CCM)

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com.

In partnership with Senior Leadership, the Utilization Management (UM) Director sets a 2-3 year strategic vision for Included Health's UM service line. This individual will oversee all Include Health UM initiatives and act as the company's UM subject matter expert. This requires someone who is a strong collaborator, excels at stakeholder relationships, is highly organized, and is a self starter.

As the UM leader, the role will also represent Included Health in external meetings with prospective and current clients, and with potential partners, representing and expounding upon Included Health's vision of utilization management.

This position will report to the Senior Director, Clinical Products & Services, at Included Health.

Responsibilities

• Accountable for the success of the Included Health UM program
• Program management of the UM program with dotted line oversight of the UM RN lead
• Exceptional coordination with internal and external resources to develop, build and execute the utilization management program
• Establishing and maintaining excellent communication and relationships with key cross-functional stakeholders
• Ensuring internal and external workflows are efficient and up-to-date
• Partnering closely with key stakeholders in Care and Case management (CCM) as well as member care operations to deliver an exceptional member experience in UM operations
• Serving as a final escalation point for workflow questions/clarifications and complex cases
• Displaying focus towards continuous improvement, pilots alternative solutions that improve team productivity, workflows, member experience, and efficiency aligning directly with our company values and goals
• Designing and implementing a quality review process for UM both internally and externally
• Responsibilities may shift over time depending on CCM and/or UM program needs
• Able to work Monday-Friday 8AM to 5PM local time

Basic Qualifications

• Bachelor's Degree required
• Master's Degree in Nursing, Hospital Administration or related field required
• Registered Nurse, in good standing with current state of licensure and with 3 years of experience as inpatient RN
• A minimum of 5 years of management experience in a health-related field, along with 3 years of experience in a quality management position
• Previous quality and workflow management experience required
• Excellent organizational skills and attention to detail required
• Data-driven and comfort in using tools to evaluate and optimize the standardization of care across our growing team
• Ability to be agile and balance multiple priorities while maintaining positive and professional attitude
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbalStrong ambition and internal drive is essential to this position
• Strong ambition and internal drive is essential to this position

Preferred Qualifications

• Project management experience preferred
• Previous Case/Care Management experience a bonus

Physical Requirements

• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner.
• This position requires frequent communication with patients and physicians; must be able to exchange accurate information during these patient encounters
• Occasional overnight business travel
• The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. FInally, this job description is not intended in any way to create a contract of employment.

The United States new hire base salary target range for this full-time position is: $118, 640 - $167,580 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry.

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