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AVP - Utilization Management (Remote) Relevant Educational Qualifications Job

5 months ago Administrative / Management Jobs Tempe   170 views
Job Details


As the AVP of Utilization Management you will have leadership and oversight of clinical operations inclusive of utilization management (UM) for CareCentrix programs and lines of business in accordance with company policies and procedures. Work with the CareCentrix leadership in Compliance, Account Management, Sales, Product, Clinical Program Development, Client Services and Business Process Excellence to establish and implement utilization management programs demonstrating best practices. Develop and implement appropriate measures designed to position CareCentrix as an industry leader for excellent clinical outcomes while obtaining optimal financial results for CareCentrix and their customers.

In this role, you will:

  • Lead and oversee Utilization Management – Clinical Operations division for CareCentrix.
  • Assure that UM activities are compliant with regulatory (CMS) and accreditation agency (URAC & NCQA standards), guidelines and client specific requirements.
  • Participate in internal and external audits of UM activities and outcomes.
  • Work with the operation's leadership management team to set priorities and goals for the clinical programs, ensuring utilization performance standards and compliance and quality standards are addressed and met
  • Work closely with the Sr. Medical Director in ensuring clinical best practices and policies are aligned
  • Participate in on-going quality assessment/improvement activities. Ensures that information is documented/identified enabling the collection and root cause analysis of data to identify opportunities for improvement related to clinical programs.
  • Oversee the development/ implementation of performance improvement plans that result in continuous quality improvement and sound clinical judgment
  • Participate in educating associates, management, customers, payers and physicians in best practices and protocols of care that drive both excellent clinical performance as well as optimizing financial results.
  • Responsible for mentoring staff involved in clinical programs, providing performance feedback to the team's management, and promoting consistency in application of program standards.
  • Assist with the development of reporting strategies and implements plans to ensure all performance outcomes are continuously monitored.
  • Work with the CCX senior leadership of Product Development to develop, direct and implement best practices for our programs.
  • Participate in sales presentations at the local, regional and national levels as required, maintaining CareCentrix as industry leader in the clinical management of home care services.

Why you are going to love this role:

  • You are passionate about fixing health care and believe that one of the best ways to do that is by helping improve the quality and access to care in the home.
  • You enjoy working with teams by building trust, fostering positive relationships and partnering with a diverse group of people.
  • You like to move fast. You enjoy working through ambiguity and a changing market environment.
  • You are fun to work with! We take our commitment to patients seriously, but we don't take ourselves seriously.


You should get in touch if you have:

  • Bachelor's degree
  • 8+ years healthcare leadership experience
  • Experience in leading remote/virtual teams
  • Clinical experience in Utilization Management across Commercial, Medicare and Medicaid lines of business and knowledge of accrediting agency standards
  • Experience with leading and developing clinical operation teams made up of Nurses and Care Coordinators
  • Experience with leading data driven performance improvement initiatives

CareCentrix maintains a drug-free workplace.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.


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Company Description
At CareCentrix, we know that our work matters and that we make a difference to our providers, clients and the patients we serve. We take pride in what we do and truly believe that our most valuable assets are our employees. We have a terrific team and are always looking to add great people as we build on our foundation and take the company to the next level.