Utilization Review & Managed Care Assistant Director, Operations (On-site)

The Utilization Review (UR) & Managed Care Assistant Director, Operations works closely with the Director, Operations to ensure that the organization, as well as its subsidiaries, is well-positioned in a rapidly evolving and competitive environment by being an agent for ongoing organizational change. The position is responsible for management and oversight of Fulfillment Operations and Assignment Operations within the Nexus office, working closely with the Director, Operations, and is responsible for the processes and functions of the daily administrative workflow process for Nexus. They will oversee daily operations, which include supervising the Operational Management Team staff performing all aspects of the UR business line. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. The Assistant Director, Operations is responsible for carrying out assignments in a manner to assure success in financial management, human resources management, leadership, quality, and operational management objectives. The Assistant Director, Operations participates in program development and unit performance improvement. The Assistant Director, Operations consistently demonstrates the core values of Nexus and serves as a role model to other team members.

Note: Viable candidates must have workers' compensation & managed care experience within a utilization management (UM) setting in the healthcare industry.

Essential Job Functions

•Reviews performance against operating plans and standards. Provides reports to subordinates, interprets results, and approves changes in direction of plans

•Presents monthly reports on performance as requested by the Director, Operations

•Develops and presents to the Director, Operations matters requiring a decision outside of their authorization level

•Develops and recommends objectives in each area of Operations

•Coordinates and collaborates with other departments of the organization in establishing and carrying out responsibilities

•Reviews operational projects involving major functional changes within the organization’s functional areas

•Works in conjunction with IT to assist in the development of plans for new areas of technology for the operational functions, along with sufficient planning for areas that support the mission of the organization within Operations

•Establishes objectives and processes governing the performance of assigned activities. Issues specific annual objectives to immediate subordinates and reviews the objectives of the Operations Management Team

•Assists in selecting and maintaining qualified personnel in all positions reporting to Operations and provides the necessary coordination between activities

•Identifies training needs, initiates development of subordinates, and recommends effective personnel action

•Participates in the development and management of department budgets and productivity targets

•Manages human resources utilization, promotes employee satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate

•Ensures that workflow operations complete client-specified work according to the client specification

•Participates in quality improvement processes and ensures implementation of regulatory standards

• Researches interdepartmental problems/issues and takes corrective action promptly, and promotes respectful, responsive communication between departments

•Establishes, evaluates, and monitors UR processes, policies, and procedures

•Supports company and departmental QA/QI initiatives

•Maintains appropriate communications within areas of responsibility

•Keeps team members informed as to the organization’s plans and progress

•Coordinates activities of assigned responsibilities with outside departments and seeks mutual agreement on problems involving coordination

•Consults with all segments of management responsible for policy or action, ensures compliance within the area of responsibility, and makes recommendations for improving the effectiveness of policies and procedures

•Provides orientation and on-the-job training for subordinates and ensures that the authority and responsibility for each position are defined and understood

•Ensures that the duties, responsibilities, authority, and accountability of all direct subordinates are defined and understood

•Assumes other activities and responsibilities from time to time as directed

Knowledge and Abilities Requirements:

•Current knowledge of utilization review processes and managed care

•Will have knowledge of or the ability to learn financial management related to UM function and reporting, quality improvement processes, and human resources management

•Will be able to effectively monitor, evaluate, and administer the resources of each assigned area and make substantiated recommendations regarding resource allocation needs for future planning purposes

•Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment

•Ability to communicate those trends found through analytical study using a variety of reporting mediums

•Proven ability to recruit, train, and motivate personnel to balance staffing strength with profitability and growth

•Ability to make recommendations for practice changes to improve the Utilization Management efforts of the department

•Ability to represent Utilization Management in organizational committees as assigned

•Excellent relationship management skills, including a high degree of professional demeanor and non-aggressive assertiveness

•Demonstrated ability to solve complex, multifaceted situations

•Ability to engage easily in abstract thought

•Strong organizational and task prioritization skills

•Strong analytical, numerical, and reasoning abilities

•Participative management type (advocates team concept)

•Well-developed interpersonal skills. Ability to get along with diverse personalities. Tactful, mature

•Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities

•Results-oriented with the ability to balance other business considerations

•Knowledge of multi-state workers’ compensation systems

•Computer literacy utilizing Microsoft Office products and database programs

•Ability to construct grammatically correct reports using standard medical terminology

Education and Experience:

•Minimum of 3 years of experience in a Worker’s Compensation Managed Care setting

•Minimum of 2 years of management experience in a Utilization Management organization

•A bachelor’s degree is preferred

License and Certification: N/A

Driving Essential: No

Position Demands:

This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information.

Equal Employment Opportunity (Our EEO Statement):

The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated.

We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.