Director, Utilization Management Operations Center Job in Rockville, Maryland Us

High profile director charged w/ strategic daily management of the utilization management operations hub including management direct reports responsibility for over 50 clinical non-clinical union line staff. Responsible for annual payroll non payroll budgets.

Essential Functions:
- Directs mentors the Utilization Management Operations Center (UMOC) management staff. Supports entire UMOC staff in attainment of department Mission Vision.
- Provides leadership direction in the identification, documentation resolution of operational barriers that interfere w/ the timely, efficient compliant processing of authorizations referrals.
- Is accountable for the health plan's Utilization Management call center (including a 24/7 unit). Ensures associated performance metrics goals are met or exceeded.
- Ensures the delivery of the department's quality management training program.
- Is accountable for assuring processes are in compliance w/ accreditation federal/state regulations as they related to authorization of services.
- Is responsible for overseeing data integrity, management reporting.
- Manages budget to comply w/ established budgetary guidelines.
Qualifications:
Basic Qualifications:
- 10 years of experience in utilization management, case management, or claims required.
- 7 years of operational management experience oversight of programs staff required.
- Master's degree in a relevant field of study (health care, business, human resources, or communications) is required.
- Previous regulatory experience working knowledge of NCQA, CMS /or TJC accreditation experience required.
- Proficient in computer applications including Microsoft Office Suite required.
- Strong interpersonal skills, w/ good verbal written communication skills required.
- Skills in problem-solving collaboration w/ other professions/disciplines required.
- Demonstrated experience in implementing initiatives or projects required.
- Skill experience in organizational change management required.
- Demonstrated leadership skills required.
- Demonstrated experience in complex strategy formulation implementation required.

Preferred Qualifications:
- 3 years of Clinical Professional Nursing or Nurse Practitioner experience either in acute care or ambulatory environment preferred.
- 3 years of direct experience w/ NCQA accreditation state/regulatory survey preferred.
- RN preferred.