Director – Utilization & Care Management Operations

ExlService Holdings   •  

Kansas City, MO

Industry: Staffing

  •  

5 - 7 years

Posted 41 days ago

Overview

The Director of Utilization & Care Management Operations will partner with physician leadership and serves as the primary leader over utilization and care management operations at a US Site. The role provides hands-on, in addition to, global operational expertise for the programs. This role is accountable for all aspects of operational excellence, with a strong focus on meeting or exceeding client commitments while driving down operational costs. Position reports to SVP, Operations.


Responsibilities

• Develop and implement effective policies and procedures and related operational processes aligned with all federal, state, regulatory, and client contracts for UM and CM operations.

• Lead and oversee new business implementations and procurement activities for site operations.

• Accountable to ensure all aspects of client service levels are met for the site operations.

• Accountable to ensure that operational teams have successful outcomes for internal and external audits and performance against regulatory requirements.

• Responsible to monitor and report operational and program metrics to senior leadership on a routine basis.

• Consistently evaluate programs, tools, and processes to improve operational performance.

• Identify staffing needs, hire and train staff.

• Effectively build, collaborate, and manage relationships with internal and external partners.

• Ensure customer focus by communicating and building rapport with clients and ensuring the "voice of the customer" is reflected in programs and business processes.

• Engage with supporting areas as needed: Finance, Marketing, Sales, Technology, Contracting, and Legal.

Qualifications


• Bachelor's degree in nursing required. Master's degree preferred.

• Active RN License in the State of Missouri or compact state is required.

• 5+ years' experience in managing operations of clinical programs for a hospital or payor.

• Must possess knowledge of UM functionality and accountability.

• Strategic thinker and strong problem-solving skills

• Strong demonstrated interpersonal and communication skills

• Self-starter, willing to dive into the details to get the work done