Sr. Utilization Management Director

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Specific: Design utilization management programs, processes and workflows to meet operational goals and anticipate future strategic needs Evaluate ability to automate and streamline standard work Analyze and monitor quality, cost reimbursement and utilization trends Develop and oversee inpatient and outpatient utilization management programs to ensure: cost-effective use of patient care resources, case delivery at the most appropriate level, collaboration with the medical staff on resource utilization issues and compliance with utilization-related private contracts, all regulating agencies, and applicable federal and state regulatory mandates General: Provide direction for health plan market/ product level operational oversight, management and performance improvement Leverage industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services Deliver innovative, integrated solutions in support of client goals and engagements. Provide delivery assurance support for engagements with assigned clients Support or lead engagements ensuring completion of contracted services: create and/ or manage to project plans, write proposals/reports, present to Client executives, and facilitate, advise and persuade key decision makers and influencers Deliver concise, clear interpersonal communication to both internal and external audiences Facilitate streamlined exchange of information with all levels of Clearlink and client organization(s) Articulate performance across multiple projects with qualitative and quantitative results/ outcomes Influence others to understand and accept strategies, goals and plans in response to changing business conditions Develop methodologies and best practices to be applied across individual account strategies/ client plans. Establish goals and track progress to ensure achievement Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model Identify opportunities to improve workflow, generate accurate, high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders Develop or update policies and procedures as required to support business needs and requirements Identify opportunities to streamline and/ or automate workflows for accurate, high quality production and improved results in cost savings, or outcomes measurement. Coach and motivate staff to reach established engagement goals, deliverables and KPIs Adapt processes, approach, plan and/ or activities in real time when targets, goals or timelines are at risk to ensure critical path activities are achieved Support account management relationships with key client decision makers Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary Responsible for the engagement quality, maintaining appropriate resources, competency training and education of staff Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager Oversee compliance with internal client related audits, support Client preparation for external audits and surveys