Director, Utilization Management & Operational Excellence

Medical Mutual; Cleveland (OH); Hybrid; USD 100,000 - 130,000; Full time

Benefits offered by this job

Health savings account matching

401(k) with company match

Tuition reimbursement up to $5,250 annually

Access to on-site fitness centers

Employee bonus program

Career development programs and classes

Discounts at local businesses

Job summary

Medical Mutual in Brooklyn, OH is seeking a Director of Managed Care Utilization Management. This hybrid role requires leadership in overseeing operations for acute and post-acute care services, ensuring adherence to regulatory standards while driving quality outcomes.

Candidates must possess a Bachelor of Science in Nursing and significant experience in managed care utilization. Responsibilities include the education and training of staff, optimizing processes, and fostering strong relationships with health systems to enhance service efficiency.

Qualifications

• 8 years of experience in managed care utilization management.
• 5 years in a leadership or project management role.
• Registered Nurse with current unrestricted license required.

Responsibilities

• Direct and oversee clinical services and operations.
• Implement departmental initiatives based on performance data.
• Develop utilization targets and monitor staff productivity.

Skills

Managed care utilization management

Process improvement techniques

Clinical claim management

NCQA accreditation standards

HIPAA compliance

Communication skills

Microsoft Office

Health insurance benefits knowledge

Education

Bachelor of Science in Nursing

Master's degree (preferred)

Tools

Microsoft Office

Job description

Medical Mutual in Brooklyn, OH is seeking a Director of Managed Care Utilization Management. This hybrid role requires leadership in overseeing operations for acute and post-acute care services, ensuring adherence to regulatory standards while driving quality outcomes.

Candidates must possess a Bachelor of Science in Nursing and significant experience in managed care utilization. Responsibilities include the education and training of staff, optimizing processes, and fostering strong relationships with health systems to enhance service efficiency.