Director, Utilization Management Operations

Job Summary: The Director, Utilization Management Operations assists the UM Department with all open projects and progress towards company and department initiatives including program descriptions, evaluations, policies, procedures, new business requirements, contract compliance and execution, and all related activities Essential Functions: Manages and prioritizes UM and related projects, and ensures timeliness and adherence to completion Responsible for gathering and prioritization of business requirements for departmental requests including regulatory reporting Monitors performance across programs to identify improvement opportunities, leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices Leads collaboration with all clinical teams and other stakeholders to ensure coordination and communication Assists with the monitoring of legislative/governmental activities with the goal of coordinating the full integration of clinical services, identifying opportunities and issues Supports the ongoing, data-driven approach to improve outcomes and experiences for members Supports and leads readiness activities for implementation of new business and programs Develops program documents and operational workflows Engages stakeholders to ensure alignment across the organization Adds services and processes related to the development of new lines of business as required Recruits, develops, and leads key staff P