Associate Director, Utilization Management - Behavioral Health - Massachusetts only

Commonwealth Care Alliance (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care, which yields improved quality outcomes and lower costs of care.Job Summary:The Associate Director, Utilization Management - Behavioral Health assists UM leadership in leading and managing all functions within behavioral health management to ensure consistent, efficient delivery of services throughout the healthcare continuum and demonstration of positive outcomes.Essential Functions:Collaborate with market and enterprise leaders to support development and knowledge transfer for Behavioral Health UMMonitor effective use of prior authorizations, policies, and benefits to ensure consistent, effective and efficient delivery to members while meeting regulations and internal financial objectivesFacilitate and promote problem identification, analysis, and resolutionProactive monitoring of regulatory requirements and meet State contract requirements for existing and new populationsEnsure Behavioral Health UM programs and operational processes are properly developed and aligned to the organization's strategic goalsDetermine benchmarks, goals and outcomes for staff and implement an accountability systemMonitor CQI activities in accordance with regulatory requirements and accreditation standardsIn partnership with UM leadership, review available reporting to analyze trends, identify opportunities and ensure alignment with polices & proceduresDevelop and coach employeesBuild succession plan inclusive of manager and teamFoster relationships with hospitals, physicians and community agencies to improve member and provider satisfactionIdentify and report risk management issues for the department and CareSource as a wholePerform any other job duties as requestedEducation and Experience:Bachelor's degree in nursing or related field required or equivalent years of relevant experience requiredMaster's degree preferredMinimum of five (5) of experience in utilization management in an MCO required; quality improvement and/or project management background preferredMinimum of three (3) years management experience requiredCompetencies, Knowledge and Skills:Proficiency in Microsoft Office products including Word, Excel and PowerPointInternet research skills preferredLeadership experience and skillsChange agentDecision making/problem solving skillsClinical data analysis and trending skillsCritical and systems thinkerKnowledge of trends in healthcare, managed care, Medicaid, behavioral health, and quality improvementExcellent communication skills, both verbal and writtenManagement skills including human capital and project managementAbility to work independently and within a team environmentAttention to detailUnderstanding of predictive modeling process/toolsTraining/teaching skillsStrategic management skillsNegotiation skills/experiencePolitically astuteProgram grammar usage, phone etiquette and technical writing skillsTime management skillsCustomer service orientedLicensure and Certification:Current, unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is requiredManaged Care, Utilization management Case Management and/or Quality Improvement certification preferredWorking Conditions:General office environment; may be required to sit or stand for long periods of timeCompensation Range:$113,000.00 - $197,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryCompetencies:- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.