UR Coordinator

Director, Operations (Utilization Management) - On-site in TX

(on-site)

Spotlight Preferred

Posted 1 day ago

Job Type: Full-Time

Job Duration:
Indefinite

Minimum Education:

BA/BS/Undergraduate

Required Travel: 0-10%

Job Function:
Director

The Director, Operations works closely with the VP, 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 directly responsible for the processes and functions and the daily administrative workflow process for Company A (name redacted), as well as its subsidiary, Company B (name redacted), and overseeing daily operations, which includes supervising the operational management team, and ensuring that the staff is performing all aspects of the Utilization Review (UR) business line and the Independent Review Organization (IRO) business lines.

The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. The 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, as well as participating in program development and unit performance improvement. The Director, Operations should consistently demonstrate the core values of Company A (name redacted) and serve as a role model to other team members.

• Reviews performance against operating plans and standards & provides reports to subordinates or interpretation of results, and approves changes in direction
• Presents monthly and ad hoc reports on performance
• Develops and presents matters requiring a decision outside of the authorization level
• Develop and recommend objectives in each area of Operations
• Develop specific short and long-term plans, processes, and programs with the supporting budget requests and financial estimates
• Coordinates and collaborates with other departments of the organization in establishing and fulfilling responsibilities
• Reviews operational projects involving major changes within the organization’s functional areas
• Develop plans for new areas of technology for the operational function, along with sufficient planning for areas that support the mission of the organization within Operations
• Establish objectives and processes governing the performance of assigned activities and issue specific annual objectives to immediate subordinates
• Reviews objectives of the Operations Management Team
• Selects and maintains qualified personnel in all positions reporting to Operations and provides the necessary coordination of 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 team member satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
• Ensure that workflow operations complete client-specified work according to the client specifications
• Participate in quality improvement processes and ensure implementation of regulatory standards
• Research interdepartmental problems/issues and take corrective action promptly, and promote respectful, responsive communication between departments
• Establishes, evaluates, and monitors UR processes, policies, and procedures
• Support company and departmental QA/QI initiatives
• Maintains appropriate communications within areas of responsibility
• Keeps subordinates/team members informed as to the organization’s plans and progress
• Coordinates activities of assigned responsibilities with outside departments
• Seeks mutual agreement on challenges involving coordination and collaboration
• Consults with all segments of management responsible for policy or action
• Ensures compliance within the area of responsibility
• Make recommendations for improving the effectiveness of policies and procedures
• Reviews and endorses or revises budget proposals received from direct reports. Submits…