Associate Director, Utilization Management - Behavioral Health - Massachusetts only

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Associate Director, Utilization Management – Behavioral Health assists UM leadership in leading and managing all functions within behavioral health management to ensure consistent, efficient delivery of services throughout the healthcare continuum and demonstration of positive outcomes.

Essential Functions:

• Collaborate with market and enterprise leaders to support development and knowledge transfer for Behavioral Health UM
• Monitor effective use of prior authorizations, policies, and benefits to ensure consistent, effective and efficient delivery to members while meeting regulations and internal financial objectives
• Facilitate and promote problem identification, analysis, and resolution
• Proactive monitoring of regulatory requirements and meet State contract requirements for existing and new populations
• Ensure Behavioral Health UM programs and operational processes are properly developed and aligned to the organization’s strategic goals
• Determine benchmarks, goals and outcomes for staff and implement an accountability system
• Monitor CQI activities in accordance with regulatory requirements and accreditation standards
• In partnership with UM leadership, review available reporting to analyze trends, identify opportunities and ensure alignment with polices & procedures
• Develop and coach employees
• Build succession plan inclusive of manager and team
• Foster relationships with hospitals, physicians and community agencies to improve member and provider satisfaction
• Identify and report risk management issues for the department and CareSource as a whole
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in nursing or related field required or equivalent years of relevant experience required
• Master’s degree preferred
• Minimum of five (5) of experience in utilization management in an MCO required; quality improvement and/or project management background preferred
• Minimum of three (3) years management experience required

Competencies, Knowledge and Skills:

• Proficiency in Microsoft Office products including Word, Excel and PowerPoint
• Internet research skills preferred
• Leadership experience and skills
• Change agent
• Decision making/problem solving skills
• Clinical data analysis and trending skills
• Critical and systems thinker
• Knowledge of trends in healthcare, managed care, Medicaid, behavioral health, and quality improvement
• Excellent communication skills, both verbal and written
• Management skills including human capital and project management
• Ability to work independently and within a team environment
• Attention to detail
• Understanding of predictive modeling process/tools
• Training/teaching skills
• Strategic management skills
• Negotiation skills/experience
• Politically astute
• Program grammar usage, phone etiquette and technical writing skills
• Time management skills
• Customer service oriented

Licensure and Certification:

• Current, unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is required
• Managed Care, Utilization management Case Management and/or Quality Improvement certification preferred

Working Conditions:

• General office environment; may be required to sit or stand for long periods of time

Compensation Range:
$113,000.00 - $197,700.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.