Utilization Management Director jobs in Mesa, AZ

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

O
Utilization Management Manager Regulatory Operations
  • Oscar Health
  • Tempe, AZ FULL_TIME
  • Hi, we're Oscar. We're hiring a UM Manager Regulatory Operations to join our Utilization Management Optimization team.

    Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

    About the role

    The UM Manager, Process Improvement works with a team of leaders, project managers, and Partners to solve business problems related to internal processes. You will identify critical processes to the business, defining the business' requirements, process mapping and assessing the effectiveness of the process, developing new or reengineering existing processes, and supporting implementation. The Manager, Process Improvement supports our teams in driving an outstanding, service-focused operation by designing and guiding the use of operational frameworks and ideologies.

    You will report to the Director UM Optimization.

    This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

    The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $108,000- $141,750 per year. The base pay for this role in all other locations is: $97,200 - $127,575per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

    Responsibilities

    • Be the example of the continuous improvement mindset, providing direction and influence, while demonstrating actual results of organizational behavior change in this area
    • Demonstrate the proper approach with implementation of Continuous Improvement Tools both internal to our organization and aligned to industry best practices
    • Partner with several leaders in all areas of the business to support the move towards core operational improvements
    • Utilize and implement programmatic frameworks and tools while adjusting your approach based on measured outcomes across simultaneous operating improvement projects
    • Create and sustain foundational stability and ensuring scalability within your responsibilities
    • Use process improvement best practices, such and Lean and Six Sigma principles, to engineer/reengineer and implement consistent organizational processes and clear engagement models
    • Provide clear context, in the form of Product Requirements Documents (PRDs), process maps, standard operating procedures and policy documents on what is being built and why it's being built.
    • Compliance with all applicable laws and regulations
    • Other duties as assigned

    Qualifications

    • A bachelor's degree or 4 years commensurate experience
    • 4 years of work experience in operations, health insurance, data analysis, engineering and/or consulting
    • 3 years of experience using data software such as Excel, SQL, Python or other data analytics tools
    • 3 years of experience with end to end project management
    • 3 years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
    • 3 years of experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints

    Bonus Points

    • Bachelor's degree in Engineering, Business Administration, or other related field
    • Lean Six Sigma Green Belt certification or higher

    This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

    At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives..

    Pay Transparency:

    Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.

    Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

    Reasonable Accommodation:

    Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

  • Just Posted

S
Director, Credit and Operations Risk Management
  • Soaren Management
  • Scottsdale, AZ FULL_TIME
  • About Soaren ManagementSoaren Management provides customer-centric alternative lending solutions in consumer markets via proprietary underwriting and loan management systems. With multiple verticals i...
  • 6 Days Ago

S
Director Quality/Risk Management
  • Steward Health Care System
  • Mesa, AZ FULL_TIME
  • Location: Mountain Vista Medical CenterPosted Date: 3/1/2024Job Type: Full TimeDepartment: 4003.70200 QUALITY AND SAFETYAbout Mountain Vista Medical CenterMountain Vista Medical Center is a 178-bed, s...
  • 21 Days Ago

A
Director of Program Management
  • ATSC IES INC
  • Gilbert, AZ FULL_TIME
  • Director of Program Management Summary: Advanced Technology Systems Company in Gilbert, AZ is looking for a Director of Program Management to join our team. The successful candidate will be responsibl...
  • Just Posted

H
Director ISC Proj Management
  • honeywell
  • Tempe, AZ FULL_TIME
  • The future is what you make it!When you join Honeywell, you become a member of our global team of thinkers, innovators, dreamers, and doers who make the things that make the future.That means changing...
  • Just Posted

P
Director, Facilities Management (At-Will)
  • Pinal County
  • Florence, AZ FULL_TIME
  • You Say Goodbye, We Say HelloSay goodbye to responding to emails after hours or having to attend work meetings while on vacation! Come work at Pinal County where you’ll have work/life balance and an e...
  • 1 Day Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Utilization Management Director jobs found in Mesa, AZ area

B
Managing Director, Utilities Customer Programs & Experience
  • Black & Veatch
  • Phoenix, AZ
  • **Managing Director, Utilities Customer Programs & Experience** Date: Mar 1, 2024 Location: US Company: Black & Veatch F...
  • 3/29/2024 12:00:00 AM

V
Director of BESS Engineering | DC (open to remote) | Utility & DG BESS
  • Viridan Group
  • Phoenix, AZ
  • Director of BESS Engineering | DC (open to remote) | Utility & DG BESS Are you a Snr Engineer in the energy storage spac...
  • 3/29/2024 12:00:00 AM

H
Director Revenue Management -Hotel
  • Hilton Phoenix Tapatio Cliff Resort
  • Phoenix, AZ
  • Job Summary: The role of the Director Revenue-Hotel is to provide direction to property teams to identify develop and im...
  • 3/28/2024 12:00:00 AM

P
Managing Director - Capital Markets
  • Pravati Capital LLC
  • Scottsdale, AZ
  • Job Summary: Pravati Capital is seeking to hire a LOCAL Managing Director to join our capital markets team. This role of...
  • 3/27/2024 12:00:00 AM

C
Director Product Management
  • Christie Digital
  • Phoenix, AZ
  • We give bright minds the tools to be truly creative and innovative. Join our team! At Christie, we create award-winning ...
  • 3/27/2024 12:00:00 AM

C
Banquet Supervisor
  • ClubCorp
  • Phoenix, AZ
  • Banquet Supervisor in Phoenix, AZ at Anthem Golf Country Club **Location:** **Job Description** Banquet Supervisor The B...
  • 3/27/2024 12:00:00 AM

U
Director, Program Manager (Credit Card)
  • USAA
  • Phoenix, AZ
  • Why USAA? Lets do something that really matters. At USAA, we have an important mission: facilitating the financial secur...
  • 3/26/2024 12:00:00 AM

Q
Deputy Managing Director
  • Quadel Consulting Corporation.
  • Phoenix, AZ
  • Job Description Job Description DESCRIPTION: Assists the Managing Director in the management of all responsibilities rel...
  • 3/25/2024 12:00:00 AM

Mesa (/ˈmeɪsə/ MAY-sə) is a city in Maricopa County, in the U.S. state of Arizona. It is a suburb located about 20 miles (32 km) east of Phoenix in the East Valley section of the Phoenix Metropolitan Area. It is bordered by Tempe on the west, the Salt River Pima-Maricopa Indian Community on the north, Chandler and Gilbert on the south along with Queen Creek, and Apache Junction on the east. Mesa is the largest suburban city by population in the United States, the third-largest city in Arizona after Phoenix and Tucson, and the 36th-largest city overall in the US. The city is home to 496,401 pe...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$124,774 to $168,718
Mesa, Arizona area prices
were up 2.2% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020