Director, Care Management & Utilization

Maine Community Health Options; Northern (KY); Híbrido; USD 133.000 - 154.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive cash compensation

Generous PTO

Future focused 401k match

Descripción de la vacante

Community Health Options seeks a Medical Management Director to oversee care management, utilization management, and the appeals process. The role requires strategic leadership to improve member outcomes, manage costs, and ensure compliance with regulatory standards.

You will lead a team, collaborate with senior leadership, and align the care management programs with CHO’s population health strategy while driving performance and quality improvements.

Formación

• Bachelor’s Degree in a related health field is preferred.
• 2-3 years of Health Plan Medical Management experience (Utilization Management and Appeals).
• Leadership experience with working knowledge of HR principles.
• Strong communication, writing, analytical and problem-solving skills.

Responsabilidades

• Develop and implement strategic plans for care management, utilization management, and appeals programs.
• Lead and mentor teams across care management, utilization management, and appeals.
• Oversee budgets and vendor contracts under CMO supervision.
• Collaborate with executives to align department goals with organizational strategy.
• Ensure regulatory compliance and quality improvement across programs.
• Monitor performance metrics and drive cost-effective care.

Conocimientos

Leadership experience

Communication skills

Analytical skills

Problem-solving

Team leadership

Educación

Bachelor’s Degree in related health field

Herramientas

Microsoft Office

Descripción del empleo

Community Health Options seeks a Medical Management Director to oversee care management, utilization management, and the appeals process. The role requires strategic leadership to improve member outcomes, manage costs, and ensure compliance with regulatory standards.

You will lead a team, collaborate with senior leadership, and align the care management programs with CHO’s population health strategy while driving performance and quality improvements.