Director of Care Management
HumanaSalary not specified
- Full Time
- Senior (5 to 8 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Data & AnalyticsIndustries
Requirements
A Bachelor's Degree is required, along with a Master's Degree in Nursing, Hospital Administration, or a related field. Candidates must be a Registered Nurse in good standing with current state licensure and have at least 3 years of experience as an inpatient RN. A minimum of 5 years of management experience in a health-related field is required, along with 3 years of experience in a quality management position. Previous quality and workflow management experience is essential, and excellent organizational skills and attention to detail are necessary.
Responsibilities
The Utilization Management Director will be accountable for the success of the Included Health UM program and will manage the UM program with dotted line oversight of the UM RN lead. This role requires exceptional coordination with internal and external resources to develop, build, and execute the utilization management program. The director will establish and maintain excellent communication and relationships with key cross-functional stakeholders, ensuring that internal and external workflows are efficient and up-to-date. They will partner closely with key stakeholders in Care and Case Management as well as member care operations to deliver an exceptional member experience in UM operations. The director will serve as a final escalation point for workflow questions and complex cases, focusing on continuous improvement and implementing a quality review process for UM both internally and externally.
Skills
Utilization Management
Quality Management
Stakeholder Management
RN
Care Management
Case Management
Workflow Management
Strategic Planning
Program Management
Relationship Management
Included Health
Healthcare advocacy and specialized care services
About Included Health
Included Health focuses on enhancing the healthcare experience for individuals who often face challenges in accessing quality care. The company provides a variety of services, including primary care, behavioral health, and virtual care, ensuring that members receive timely and appropriate treatment. Their model emphasizes 24/7 on-demand care with a diverse group of providers, allowing for personalized support tailored to complex health needs. Unlike many competitors, Included Health prioritizes underserved populations and partners with employers and consultants to deliver comprehensive healthcare solutions that not only improve health outcomes but also help reduce costs. The ultimate goal of Included Health is to make quality healthcare accessible and understandable for everyone, particularly those who have been overlooked by traditional healthcare systems.
Key Metrics
San Francisco, CaliforniaHeadquarters
2020Year Founded
$337.5MTotal Funding
GROWTH_EQUITY_VCCompany Stage
HealthcareIndustries
51-200Employees