Under the supervision of the Medical Director of Behavioral Health, the Director of Utilization Management is directly responsible for the planning, organization, strategic direction, staffing and development of Colorado Access’ Utilization Management program. The Director ensures that activities are appropriately aligned with our mission, values, and strategic imperatives. This position provides day-to-day direction to UM staff including maintenance of adequate staffing, assurance of adequate staff training and ongoing education, and direction of the operations of utilization management activities, and prior authorization functions inclusive of the timely notification of high quality decisions. Provides clinical support and communicates with departmental and plan administrative staff to facilitate daily department functions, in accordance with regulatory and contractual guidelines.
Directs and develops the UM program annually and ensures the success of UM functions through medical review and prior authorization, behavioral health management, clinical intake, and inpatient and outpatient review.
Directs and develops specialty programs to support and ensure success of the UM program, inclusive of innovative programs that emphasize and utilize hospital collaborative work relationships, and internal and external partnerships; ensures compliance and administration of utilization policies through cost effective management of UM operations.
Develops, secures approval and monitors and reports on area operating budget; forecasts spending levels, staffing requirements and resource needs for area.
Provides overall direction, design, development implementation and monitoring of utilization programs to meet utilization goals while maintaining customer satisfaction.
Acts as a resource to the medical staff, administrative staff, and external regulatory agencies in all issues relating to utilization management.
Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
Education: Master’s degree in behavioral health field, nursing, health services administration, or other related health care field; or an equivalent combination of education and experience.
Experience: Ten years of healthcare experience required, with five years in a managed care environment with progressive management experience. Must have experience in effectively managing a diverse group of professionals with varying backgrounds. Experience with program development and implementation required. Experience working with the Medicaid population and in a managed care setting preferred. Must have some public speaking experience.
Knowledge, Skills, and Abilities: Demonstrated interpersonal, negotiation, and leadership skills. Effective oral and written communication skills Ability to work independently and set priorities and meet challenging goals. Excellent time management skills with the ability to multi-task required. Knowledge of managed care, case management, utilization management, and systems which are integrated with Medical Management. Must be able to direct staff in a manner that promotes team building and communication. Must have excellent written and verbal communication and presentation skills. Must have working knowledge of word processing and spreadsheet programs, preferably in Microsoft Office. Knowledge of care coordination/utilization management software preferred. Knowledge of ICD-10, CPT4, HCPC coding required.
Licenses/Certifications: Licensure in field of study is required. A valid driver's license and proof of current auto insurance will be required.
Additional Salary Information: 9 hours PTO accrued every pay period (Bi-monthly)
Continuing Education/development dollars per year
10% Bonus potential every year
We are a nonprofit health plan that provides access to behavioral and physical health services for Coloradans. Below is a list of our current lines of business:
About Access Long Term Support Solutions
About Access Behavioral Care
About Child Health Plan Plus offered by Colorado Access
About the Regional Care Collaborative Organization (RCCO)
We also provide administrative services for the ...CHP+ State Managed Care Network and CHP+ Prenatal Care Program.
Healthy communities transformed by the care that people want at a cost we can all afford.
Partner with communities and empower people through access to quality, affordable care.
It began with a vision to increase equal access to high quality care for medically underserved Coloradans.
Twenty years ago, Children's Hospital Colorado, University Physicians, Inc., Colorado Community Managed Care Network, and University of Colorado Hospital founded our nonprofit organization with the belief that everyone, regardless of income or circumstance, should have access to quality, affordable care. That belief became our legacy and it still lives on today in our mission.
We are community oriented and driven by the needs of our members. Through regular provider and consumer advisory, engagement, and partnerships, we work to strengthen the communities we serve through access to quality care. We are proud to be local and mission driven and we will never lose sight of why we're here and whom we serve.
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Nothing is more important than the trust of our members, providers, partners and employees. We operate with integrity at all times and we follow rules and regulations as a matter of principle, not obligation.
We are driven by helping those we serve achieve positive results. We strive to exceed expectations and create a positive experience for our customers and employees. We demonstrate accountability for delivering high performance, strong results, value-added operations and quality service.
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