Skip to content
CV Rocket
Get started
How it worksThe enginePricingBlogContactSign in

Open nowPosted 2 days ago

UM Operations Strategy Implementation Lead

CareSource134 open roles

Pay
$83,000 – $132,800 a year
Where
Remote
Work mode
Remote
Get the CV for this job

From $25 per CV, paid once. No subscription.

Your applicationOpen nowUM Operations Strategy Implementation LeadCareSource · Remote

  1. YouYes, apply to this one.

  2. CV RocketCV written for this posting.

  3. 25 readersRecruiter, hiring manager, skeptic. Round after round.

  4. CV RocketApplied on CareSource's own form.

The reply lands in your private mailbox

3×more interviews than doing it yourself with ChatGPT.

The clock on this job

Early applications get read.

13.1% of postings close within 7 days. Measured by our own scanner across the market. CareSource postings stay open a median of 10 days.

Share of postings closed within
  1. 2.2%1 day
  2. 4.7%3 days
  3. 13.1%7 days
  4. 21.1%14 days
  5. 35.7%30 days
  6. 58.7%60 days
This job: posted 2 days ago

CareSource median: 10 days open

The posting

Job Summary:

The Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM department. This role will also drive key process changes and identify key gaps and variances across the department.

Essential Functions:

  • Utilize process controls to achieve operational excellence in all areas within the department
  • Actively work with UM leadership in closing variances of identified risks to compliance
  • Utilize process improvement frameworks to drive continuous improvement
  • Assess data to identify any misalignment with compliance, regulatory and operational requirements and support process changes that result from any identified opportunities
  • Collaborate with analytics, Physical Health and Behavioral Health clinical teams, compliance and regulatory to ensure regulatory content is represented in the data sets and validated
  • Assist in implementations of changes through systematic and measurable actions ensuring regulatory, accreditation, and compliance business goals are met
  • Assist in the creation of the UM (including Clinical responses) for the NQTL data and narrative submissions
  • Proactively build and manage various relationships to improve standardization and interdepartmental collaboration on enterprise goals and initiatives
  • Provide Clinical and UM support on parity associated internal compliance workgroups
  • Work collaboratively with the appropriate departments to define and utilize outcome measurements, and support a culture of compliance
  • Partner as needed with other departments to support in the implementation of process improvement opportunities, new business rules, new products and delegations
  • Support change management initiatives that impact the department
  • Assist in analysis and recommendations for annual product filings and UM strategy from a parity perspective
  • Perform any other job duties as requested

Education and Experience:

  • Bachelor’s degree in healthcare, population health or related field, or equivalent years of relevant work experience is required
  • A minimum of five (5) years of experience in UM or related to the responsibilities of this position is required
  • Previous experience with quality control and/or process standards is preferred

Competencies, Knowledge and Skills:

  • SME in federal/state laws and regulations
  • Proficient use of Microsoft Office Suite, to include Word, Excel, PowerPoint, Outlook, and Visio with a strong willingness to learn
  • Ability to analyze processes across multiple functional areas
  • Ability to work independently and within a team environment
  • Understanding of ROI and risk avoidance
  • Demonstrated change management and continuous improvement leadership knowledge
  • Ability to gather data and create meaningful analysis
  • Ability to review and implement evidence-based trends
  • Strong oral, written and interpersonal communication skills
  • Strong understanding NCQA and/or CMS, accreditation and audit standards with knowledge of regulatory reporting, and compliance requirements
  • Strong attention to detail and time management skills
  • Effective problem-solving skills with attention to detail
  • Effective listening and critical thinking skills

Licensure and Certification:

  • Current, unrestricted Registered Nurse (RN) licensure is preferred
  • Six Sigma or project management certifications are preferred

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$83,000.00 - $132,800.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-JM1

Brand=CareSource

From $25, paid onceGet the CV for this job

What happens when you press

One press. We do the rest.

  1. A CV for this posting

    Written against CareSource's own wording, from every piece of relevant proof in your profile.

  2. 25 readers review it

    Recruiter, hiring manager, skeptic and more read every draft, round after round. You get the best round.

    The review screen in CV Rocket: how each CV was read, round by round.

  3. We apply on CareSource's form

    Our application engine gets through the hardest forms there are. Where a question needs you, AI suggests the best answer. Don't want us applying from our IP addresses? Use our Chrome extension: we apply straight from your own browser.

    An application in CV Rocket: every answer filled in on the employer's form.

  4. Every reply, sorted

    CareSource's answer lands in your private mailbox, and we classify it on arrival: interview, question, rejection.

    The CV Rocket inbox: each employer reply classified as an interview, an action or a rejection.

  5. Reply with AI

    AI helps you write the email, checks it and sends it. We show you whether the recruiter read it.

  6. The interview in your calendar

    Full integration with your calendar. The invitation goes straight in.

    An interview invitation in the CV Rocket inbox, added to the candidate's calendar.
Get the CV for this job

From $25 per CV, paid once. No subscription.

Why it works

3×

more interviews than doing it yourself with ChatGPT.

ChatGPT writes a CV and never learns what happened to it. We see every reply. For each CV we know:

  • How it was written, and how the review scored it
  • When we applied, and how long after the posting went up
  • Which posting, which company, which city
  • Who got the interview, and who heard nothing

That is how we know which CVs get called.

Get the CV for this job

From $25 per CV, paid once. No subscription.

The numbers game

More applications. More interviews.

Every application goes out with its own CV, written for that posting and paid once. Send enough of them and the law of large numbers finds you the job.

Get the CV for this job
By hand5–10
With CV Rocket100
applications a day

Nearby

Live postings like this one

Same employer first, then the same role elsewhere.

Before you press

Straight answers

Get the CV for this job

From $25 per CV, paid once. No subscription.

What if my background isn't good enough?

We make the most of the background you have. The CV uses every piece of relevant proof your profile holds, and one of the 25 readers reads your whole profile and flags what the CV left out.

Do you really apply for me?

Yes, on the employer's own form, the hardest ones included. Where a question needs you, you answer it right there and AI suggests the best answer. Don't want us applying from our IP addresses? Use our Chrome extension: we apply straight from your own browser.

Is it a subscription?

No. You pay once per CV, from $25. Every application goes out with its own CV, written for that posting.

One job. One CV.
Paid once.

Pick the posting you want. We write for it, apply for you and catch the reply.

Get the CV for this job

From $25 per CV, paid once. No subscription.