UM Strategy & Process Improvement Lead

CareSource; Dayton (OH); Hybrid; USD 83,000 - 133,000; Full time

Job summary

CareSource in Dayton, OH is seeking an Utilization Management (UM) Operations Strategy & Implementation Lead to oversee all operational and compliance activities that support UM. You will drive key process changes, close variances, and collaborate across clinical and regulatory teams to ensure data accuracy and regulator readiness.

The role requires strong process improvement skills, experience in UM or related fields, and the ability to build cross-functional partnerships to achieve enterprise

Qualifications

• Bachelor’s degree in healthcare, population health or related field.
• Minimum five (5) years of experience in UM or related to the responsibilities of this position.
• RN licensure preferred; Six Sigma or project management certifications preferred.
• Previous experience with quality control and/or process standards is preferred.

Responsibilities

• 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 misalignment with compliance, regulatory and operational requirements and support process changes.
• 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.

Skills

Microsoft Office Suite

Education

Bachelor's degree in healthcare or related field

Job description

CareSource in Dayton, OH is seeking an Utilization Management (UM) Operations Strategy & Implementation Lead to oversee all operational and compliance activities that support UM. You will drive key process changes, close variances, and collaborate across clinical and regulatory teams to ensure data accuracy and regulator readiness.

The role requires strong process improvement skills, experience in UM or related fields, and the ability to build cross-functional partnerships to achieve enterprise