CareSource Logo

CareSource

UM Operations Strategy & Implementation Lead - UM Focused

Sorry, this job was removed Sorry, this job was removed at 07:47 a.m. (PST) on Sunday, Mar 09, 2025
Be an Early Applicant
Remote
81K-130K Annually
Remote
81K-130K Annually

Similar Jobs

13 Days Ago
Remote
6 Locations
23-30
Mid level
23-30
Mid level
Insurance • Real Estate
The Title Examiner searches public records, examines residential property titles, resolves issues, prepares documentation, and ensures legal compliance.
Top Skills: Company Operating SystemsMS Office
25 Days Ago
Remote
4 Locations
170K-180K Annually
Senior level
170K-180K Annually
Senior level
Healthtech
As a Senior Manager for Regional Field Education at Medtronic, you will lead the development and execution of training strategies for sales representatives and clinical specialists, ensuring product knowledge and procedures enhancements. You will also manage a team, drive engagement, and solve high-level problems within the Cardiac Ablation Solutions unit.
16 Days Ago
Remote
New York, NY, USA
67K-121K Annually
Entry level
67K-121K Annually
Entry level
Insurance
As an Early Career Trial Attorney, you'll manage insurance defense litigation, conduct legal research, prepare legal documents, and represent clients in court proceedings. You'll also stay informed about changes in laws and regulations and participate in mentorship programs.

Job Summary:

The Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM department. This role will also drive key process changes and identify key gaps and variances across the department.

Essential Functions:

  • Utilize process controls to achieve operational excellence in all areas within the department
  • Actively work with UM leadership in closing variances of identified risks to compliance
  • Utilize process improvement frameworks to drive continuous improvement
  • Assess data to identify any misalignment with compliance, regulatory and operational requirements and support process changes that result from any identified opportunities
  • Collaborate with analytics, Physical Health and Behavioral Health clinical teams, compliance and regulatory to ensure regulatory content is represented in the data sets and validated
  • Assist in implementations of changes through systematic and measurable actions ensuring regulatory, accreditation, and compliance business goals are met
  • Assist in the creation of the UM (including Clinical responses) for the NQTL data and narrative submissions
  • Proactively build and manage various relationships to improve standardization and interdepartmental collaboration on enterprise goals and initiatives
  • Provide Clinical and UM support on parity associated internal compliance workgroups
  • Work collaboratively with the appropriate departments to define and utilize outcome measurements, and support a culture of compliance
  • Partner as needed with other departments to support in the implementation of process improvement opportunities, new business rules, new products and delegations
  • Support change management initiatives that impact the department
  • Assist in analysis and recommendations for annual product filings and UM strategy from a parity perspective
  • Perform any other job duties as requested

Education and Experience:

  • Bachelor’s degree in healthcare, population health or related field, or equivalent years of relevant work experience is required
  • A minimum of five (5) years of experience in UM or related to the responsibilities of this position is required
  • Previous experience with quality control and/or process standards is preferred

Competencies, Knowledge and Skills:

  • SME in federal/state laws and regulations
  • Proficient use of Microsoft Office Suite, to include Word, Excel, PowerPoint, Outlook, and Visio with a strong willingness to learn
  • Ability to analyze processes across multiple functional areas
  • Ability to work independently and within a team environment
  • Understanding of ROI and risk avoidance
  • Demonstrated change management and continuous improvement leadership knowledge
  • Ability to gather data and create meaningful analysis
  • Ability to review and implement evidence-based trends
  • Strong oral, written and interpersonal communication skills
  • Strong understanding NCQA and/or CMS, accreditation and audit standards with knowledge of regulatory reporting, and compliance requirements
  • Strong attention to detail and time management skills
  • Effective problem-solving skills with attention to detail
  • Effective listening and critical thinking skills

Licensure and Certification:

  • Current, unrestricted Registered Nurse (RN) licensure is preferred
  • Six Sigma or project management certifications are preferred

Working Conditions:

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

Compensation Range:

$81,400.00 - $130,200.00

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 (hourly/salary):

Salary

Organization Level Competencies

  • Create an Inclusive Environment

  • 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 inclusive environment that welcomes and supports individuals of all backgrounds.

What you need to know about the Seattle Tech Scene

Home to tech titans like Microsoft and Amazon, Seattle punches far above its weight in innovation. But its surrounding mountains, sprinkled with world-famous hiking trails and climbing routes, make the city a destination for outdoorsy types as well. Established as a logging town before shifting to shipbuilding and logistics, the Emerald City is now known for its contributions to aerospace, software, biotech and cloud computing. And its status as a thriving tech ecosystem is attracting out-of-town companies looking to establish new tech and engineering hubs.

Key Facts About Seattle Tech

  • Number of Tech Workers: 287,000; 13% of overall workforce (2024 CompTIA survey)
  • Major Tech Employers: Amazon, Microsoft, Meta, Google
  • Key Industries: Artificial intelligence, cloud computing, software, biotechnology, game development
  • Funding Landscape: $3.1 billion in venture capital funding in 2024 (Pitchbook)
  • Notable Investors: Madrona, Fuse, Tola, Maveron
  • Research Centers and Universities: University of Washington, Seattle University, Seattle Pacific University, Allen Institute for Brain Science, Bill & Melinda Gates Foundation, Seattle Children’s Research Institute
By clicking Apply you agree to share your profile information with the hiring company.

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account