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Job Description:

Select Health is a community health plan serving more than 1 million members. Select Health’s line of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans.

This leader is responsible for the development, implementation, evaluation, and operational management of utilization review programs to include prior authorization, acute and post acute concurrent review for various service lines of business(s). The position requires an understanding of utilization management industry benchmarks, best practices and regulatory environment for the line of business function.

This position leads a team of caregivers and strategy as assigned to their applicable role.

Essential Functions

+ Supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey.

+ Oversees program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the department leader in scaling utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way.

+ Ensures Select Health offers competitive programs, monitors medical expense trends for the product lines and works with senior leadership to evaluate or add programs to impact trends.

+ Uses a data-driven approach to assess utilization management and care management operations and make program recommendations.

+ Concurrent review: develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery.

+ Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of Select Health.

Skills

+ Leadership

+ Communication

+ Health plan functions

+ Utilization review

+ Care management

+ Performance management

+ Change management

+ Interqual expertise

Qualifications

Minimum Qualifications

+ Bachelor's or master’s degree in clinical specialty, such as Nurse, LCSW, Nurse Practitioner, Physician's Assistant, Physical or Occupational Therapy. Education is verified.

+ Current associated clinical license in state of Utah.

+ Experience working in a managed care environment and have familiarity with the regulatory environment pertinent to the Line of Business (LOB) they will oversee (e.g. NCQA, CMS).

+ Three years of clinical experience, preferably in a variety of settings.

+ Previous leadership or management experience in a managed care environment including organizational and program development skills requiring demonstrated knowledge of care management, utilization management and insurance industry.

+ Experience with financial reporting and analysis, preferably in a managed care setting.

+ Demonstrated problem-solving ability.

+ Demonstrated excellent verbal, written and interpersonal communication skills.

+ Demonstrated public speaking and presentation skills.

+ Demonstrated Experience Leading a team

Preferred Qualifications

+ Three years of HMO care / utilization management experience.

Physical Requirements:

Physical Requirements

+ Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.

+ Frequent interactions with providers, colleagues, customers, and members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.

+ Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

+ May be expected to sit or stand in a stationary position for a long time.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$57.75 - $89.14

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.