University of Utah Health Health Plans Director - Clinical Operations in Murray, Utah

Overview

University of Utah Health Plans (UUHP) is seeking a new Health Plans Director of Clinical Operations!

This department focuses on three key areas in the Health Plans / Insurance environment: Care Management, Utilization Management, and Quality Improvement. If you're a Registered Nurse or Licensed Clinical Social Worker with 6+ years of leadership experience directly in these fields, we'd love to hear from you!

The Health Plans Director of Clinical Operations will oversee all employment, policy, and process development, and will have responsibility of financial oversight for clinical operations. The position reports to the Health Plans Chief Medical Officer and will be a part of the Health Plans leadership team.

Our ideal candidate is experienced and skilled in:

  • Managing and directing case management, utilization review, and quality improvement in a healthcare or health insurance (preferred) environment with payer/provider relationships.

  • Providing strategic direction, so health plans can grow while facilitating better healthcare at a lower cost.

  • Overseeing Health Plan Accreditation processes for all Lines of Business.

  • Working with governmental and community partners to assure strong alliance in supporting overall healthcare needs of UUHP members.

  • This position will also serve as the face of the organization to our partners and community, and will require the ability to gain the confidence and trust of Health Plans’ clients that both the personal and financial interest of their members will be secure.

  • This position has no responsibility for providing care to patients.

University of Utah Health was ranked 35th in the nation, and is the only health care provider from the state of Utah to receive the designation as one of America’s Best Large Employers by Forbes in 2018! We credit our employees for our national ranking as a top 10 academic medical center for quality and safety for eight consecutive years. Not surprisingly, health care organizations with higher levels of staff engagement also have higher patient satisfaction scores, better staff retention, and a stronger culture of safety.

University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. It’s a great place to work and live, and the nation is taking note! EO/AA

Responsibilities

Knowledge / Skills / Abilities

  • Ability to gain the confidence and trust of Health Plans’ clients that both the personal and financial interest of their members will be secure.

  • Knowledge and problem solving skills to ensure that diverse patient/customer, family and community issues affecting member service and care are resolved.

  • Ability to plan and administer the department’s budget and make spending decisions within budget guidelines.

  • Ability to oversee program development for assigned units and ensure that policies and procedures are followed.

Building Relationships

  • Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

  • Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Talent Management

  • Hiring, training, developing, and communicating with staff.

Financial Management

  • Responsible for developing, monitoring and achieving budget goals.

  • Manages labor and non-labor expenses to budget or flex budget.

  • Manages revenue to budget to maximize potential revenue.

EPE/Service

  • Responsible for patient satisfaction scores within assigned area(s).

  • Responsible for upholding PROMISE standards of direct reports and team members.

Quality

  • Responsible to achieve quality goals for assigned area(s).

  • Manages and promotes continuous process improvements in assigned area(s)

Performance Management

  • Responsible to provide staff feedback on performance, including on-time appraisals and coaching.

  • Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Qualifications

Required

  • Bachelor degree in Health Care Administration, Business Administration, or related area or equivalency.

  • Six years experience in healthcare management preferably with Health Plan experience.

One of the following:

  • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. If not changing state of practice to Utah, current license to practice as a Registered Nurse in a state covered by the Interstate Compact.

  • Current Utah Licensed Clinical Social Worker (L.C.S.W.) certificate for clinical practice.

Qualifications (Preferred)

  • Experience in Case Management, Utilization Management, and Quality Improvment.

  • Master’s degree in Health Care Administration, Business Administration, or related area.

  • Basic Life Support Health Care Provider card, or obtain within one month of hire.

Physical Requirements

Listening, Speaking, Standing

Requisition Number 30099

Reg/Temp Regular

Employment Type Full-Time

Shift Day

Work Schedule Office hours

Location Name University of Utah Health Plans

City Murray

State UT

Department UIP CST 01H UUHP CLINICAL OPRN

Category Insurance / Health Plans

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.