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Job Description:

The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization Management and Review for the Enterprise. The individual works in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders to ensure application of appropriate standards of practice, the provision of optimal patient level of care, and attainment of financial goals.

Reporting to the Sr. Director/AVP/VP Utilization Management, the role of the Director for Utilization Management is critical to the success of our members and the Utilization Management (UM) department in realizing its goals and objectives. As the Director you will play a key role as part of UM team in delivering and collaborating on all aspects of utilization management and care coordination for membership in the Desert Region. The Director, role will provide direction and leadership in compliance to regulatory requirements and key operational metrics.

Leads the system-wide development of partnerships with payors to support Utilization Management.

Collaborates with Castell, Home Care, Clinic Management and Operations teams to develop strategic, operational and technology solutions to improve safety, quality, patient experience, and access, while reducing the cost of care delivered.

Leads NCQA Utilization Management Accreditation, Survey Process, and updated annual standard review for compliance.

Develops growth opportunities in new states setting up workflows for multimodal care management capabilities.

Minimum Qualifications

Master’s Degree in Nursing or Healthcare Administration. Degree must be obtained through an accredited institution. Education is verified.

Hold and maintain a professional license in nursing.

Knowledge and oversight for compliance with government regulations, contractual requirements and NCQA accreditation.

Eight years of professional progressive experience in health care delivery or Three years of experience leading Utilization Management case management requiring knowledge of the current healthcare environment, healthcare regulatory matters and healthcare reimbursement.

Experience in contract negotiations.

Experience in a role requiring strategic thinking and planning skills and the ability to develop proposals, pilots and projects from conception to implementation.

Experience using word processing, spreadsheet, database, internet, e-mail and scheduling applications.

Experience in a role requiring effective verbal, written and interpersonal communication skills.

Preferred Qualifications

Professional experience working in an integrated delivery system that includes a health plan.

Experience in directing other clinical areas, working closely with physicians, and developing clinical strategies, implementing operational efforts and measuring outcomes.

Experience evaluating technology solutions to support care management functions

Experience with developing collaborative relationships with payors to address healthcare needs across the continuum

Physical Requirements:

Physical Requirements

Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.

Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.

See and read computer monitors and documents.

Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

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

$66.41 - $102.52

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.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.