Assistant Director of Utilization Management

 
Position: Assistant Director of Utilization Management

Job ID: 164366

Location: US-TX-Houston

Department: UTILIZATION MGMT - ADMIN

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of the patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for an Assistant Director of Utilization Management -- someone who works well in a fast-paced setting. In this position, you will provide oversight and supervision to the Utilization Management staff for the delivery of exceptional medical management services to Texas Children's Health Plan members and to continually develop medical management processes in response to analysis and research of managed care trends and benchmarks as well as the strategic goals of Texas Children's Health Plan. To support and develop staff through equitable distribution of resources and assignments, education and implementation of processes and procedures for medical management programs of Texas Children's Health Plan.

 

Think you’ve got what it takes



Responsibilities :

  • Plan, develop, organize, direct implement, and monitor a coordinated approach to medical management services for TCHP members and meet the obligation of contractual agreements and legislative regulations.
  • Provides oversight and analysis of Utilization Management services, evaluation of benefit delivery, health trends, and complaint findings.
  • Develops approaches, policies, and programs for medical management which are based on the TCHP goals and objectives, and which meet the TCHP performance goals.
  • Supports the delivery of cost-effective, community-based, and culturally sensitive health care through appropriate delivery of utilization management processes that address values of quality, service, and cost-effectiveness.


Qualifications:

Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption

  • Bachelor's Degree
  • Licenses/Certifications: CSW - Lic Clinical Social Worker by the Texas State Board of Social Work Examiners, LMSW - Licensed Master Social Worker by the Texas State Board of Social Work Examiners, RN - Lic-Registered Nurses by the Nurse Examiners for the State of Texas
  • 5 years’ experience in health delivery or a managed care organization and 2 years of supervisory experience


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