Job Description:
SelectHealth is a not-for-profit community health plan serving more than one million members in Utah, Idaho, and Nevada. As part of an integrated system with Intermountain Healthcare, we share a mission of “Helping people live the healthiest lives possible” to ensure our members and the communities we serve have the highest quality healthcare at the lowest possible cost.
SelectHealth’s line of businesses (LOB) include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and fully-funded and self-funded Commercial plan. The Healthy Connections Director is responsible for the development, implementation, evaluation, and operational management of SelectHealth’s Healthy Connections care management and utilization review programs for the line of business(s) which this position oversees. The position requires an understanding of care management and utilization management industry benchmarks, best practices and regulatory environment for the line of business function.
This position is based out of the SelectHealth office in Murray, Utah and required regular in-office presence 2-3 days per week.
Reporting to the Senior Director of Health Connections, this position supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey. It oversees all Healthy Connections program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the Senior Director and CMO in scaling care management and utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way.
Ensures SelectHealth offers competitive programs, monitors medical expense trends for the product line and works with CMO and Senior Director to evaluate or add programs to impact trends. Uses a data-driven approach to assess utilization management and care management operations and make program recommendations. For Interdisciplinary Care Management, develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery. Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of SelectHealth.
In addition, the position oversees effective services and outcomes for members by monitoring the care management process. Supports management team in leading daily operations of their respective disciplines. Establishes standards for staffing and case load management based on industry benchmarks for comparable programs and guides leadership team to assure standards for documentation, policies and procedures are met. Is actively involved in maintaining quality practice as defined by NCQA, CMS and / or other regulatory agencies. Leads change initiatives and acts as a subject matter expert sharing an understanding and explaining organizational, regulatory and operational changes to the teams in assigned line of business. Has clear understanding of organization and department goals and how the work aligns with strategies and uses that knowledge to align messaging and expectations with the leadership team and helps the team solve problems and offer alternate solutions.
Minimum Qualifications
- Bachelor’s or master’s degree in clinical specialty, such as Nurse, LCSW, Nurse Practitioner, Physician’s Assistant, Physical or Occupational Therapy. Education is verified.
- Current associated clinical license in state of Utah.
- Experience working in a managed care environment and have familiarity with the regulatory environment pertinent to the Line of Business (LOB) they will oversee (e.g. NCQA, CMS).
- Three years of clinical experience, preferably in a variety of settings.
- Previous leadership or management experience in a managed care environment including organizational and program development skills requiring demonstrated knowledge of care management, utilization management and insurance industry.
- Experience with financial reporting and analysis, preferably in a managed care setting.
- Demonstrated problem-solving ability.
- Demonstrated excellent verbal, written and interpersonal communication skills.
- Demonstrated public speaking and presentation skills.
Preferred Qualifications
- Experience working in Medicaid programs (e.g. waiver programs, programs that restrict over-utilizers, familiarity with unique Medicaid state rules, etc.)
- Experience running government program(s) and leading these teams
- Familiarity with federally qualified health centers, community-based behavioral health services, inter-disciplinary team conferences, building and staffing models of care for care management.
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Physical Requirements:
Location:
SelectHealth – Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$56.61 – $87.39
For a description of Intermountain’s employment benefits, click
HERE.