senior director applications manager Remote
Job description
BRING YOUR PASSION FOR IMPROVING THE DELIVERY OF PATIENT CARE--Remote opportunity in California.
Our client, a progressive, successful managed care organization is looking for an innovative, energetic Utilization Management professional. The Senior Director will be responsible for all Delegation Oversight activities pertaining to Utilization Management and Case Management areas.
This highly visible position will function as the primary liaison and advisor to affiliated medical groups, health plans, and UM/CM business units.
Join a collaborative, high-performing team with members who support one another and strive to maintain a work-life balance.
Responsibilities include:
- Creates and implements compliance activities for Utilization and Case Management functions
- Develops, implements, and maintains a comprehensive Delegation Oversight Program for affiliated medical groups
- Proactively monitors affiliated medical groups to ensure regulatory and accrediting requirements are met
- Leads DMHC and NCQA preparation for Utilization and Case Management
- Provides leadership for the health plan and compliance oversight team
- Ensures health plan performance standards are maintained
- Directs delegation oversight activities related to annual oversight audits, focused audits, and corrective action plans (CAPs)
- Hires, trains, and mentors a high-performing team
- Develops, implements, and monitors departmental metrics
- Assures compliance with HIPAA requirements
Qualifications:
- Graduate from an accredited school for Nursing
- Active and unrestricted California RN or LVN license
- Advanced degree preferred but not required
- Requires a Subject Matter Expert in the California and federal managed care regulatory environment
- Minimum 5 years leadership experience at Director level or above
- Minimum 5 years Utilization Management experience in a health plan, MSO, IPA, or medical group setting
- 5-7 years of clinical experience preferred
- In-depth knowledge of regulatory requirements including DMHC, DHCS, CMS, and NCQA
- Proficient in MS Office programs
- Strong analytical and creative problem solving skills
- Ability to multi-task in a fast-paced environment
Job Type: Full-time
Pay: $180,000.00 - $200,000.00 per year
Benefits:
- Disability insurance
- Employee assistance program
- Flexible spending account
- Relocation assistance
Physical setting:
- Office
Schedule:
- 8 hour shift
- Monday to Friday
Supplemental pay types:
- Bonus pay
- Signing bonus
Work Location: Remote
