Top 485 Director, utilization management & operational integrity Jobs in Copley, Oh

Director, Utilization Management & Operational Integrity
Medical Mutual of Ohio —Cleveland, OH
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- Disability insurance
HOSPICE MEDICAL DIRECTOR - Palliative Care (JC432)
ilocatum —Akron, OH
- $100,000 - $200,000 a year
- Contract
- Medicine
- Senior level
- Hospice & Palliative Medicine
Quick Apply
Director of Planning
City of Green —Green, OH
- $105,000 - $115,180 a year
- Email
- Management
- 5 years
- Office
- Health savings account
- Health insurance
Quick Apply
9d
Director of Engineering
Tribotech Composites Inc —Cleveland, OH
- $100,000 - $120,000 a year
- Full-time
- Background check
- Office
- Fair chance
- Health insurance
- Dental insurance
Quick Apply
Social Services Director
Confidential —Cuyahoga Falls, OH
- Full-time
- Experience working with individuals with developmental disabilities
- Master's degree
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
10d
Director of Pharmacy (DOP)
Regency Hospital - Cleveland East —Warrensville Heights, OH
- Full-time
- BLS Certification
- Inpatient
- 3 years
- Health insurance
- Dental insurance
Quick Apply
5d
Early Childhood Program Director
Hudson United Methodist Church —Hudson, OH
- From $20,000 a year
- Part-time
- No background check
- Preschool
- Senior level
Quick Apply
4d
Admissions Director
Falls Village Rehabilitation and Wellness —Cuyahoga Falls, OH
- From $65,000 a year
- Full-time
- Background check
- Skilled nursing facility
- Public speaking
- Free parking
- Continuing education credits
Quick Apply
Director of Operations
Serving Area Military and Veterans —Canal Fulton, OH
- Full-time
- Background check
- US work authorization
- In-person
- Paid time off
Quick Apply
Director of Marketing
DealPoint Merrrill —Cleveland, OH
- $125,000 - $130,000 a year
- Full-time
- Hospitality
- 7 years
- Marketing
- Health insurance
- Dental insurance
Quick Apply
Assistant Director of Nursing (ADON)
Green Village Rehabilitation and Wellness —Akron, OH
- Full-time
- Background check
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
2d
Director of Plant Operations
Confidential —Cleveland, OH
- $65,000 - $70,000 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Children's Ministry Director
Faith Community Fellowship —Massillon, OH
- $29,000 a year
- Part-time
- Background check
- Classroom
- CPR Certification
- Paid time off
- Flexible schedule
Quick Apply
Director of Business Development
Pleasant Valley Corporation —Medina, OH
- Full-time
- 5 years
- Office
- Bachelor's degree
Quick Apply
Director of Business Development
Alair Homes Solon —Solon, OH
- $70,000 - $75,000 a year
- Full-time
- Hybrid work
- Background check
- Business development
- US work authorization
- 401(k)
- Paid time off
Quick Apply
Maintenance Director - Long Term Care Facility
Confidential —Cleveland, OH
- From $55,000 a year
- Full-time
- Skilled nursing facility
- Nursing home
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
5d
Regional Field Director
Field Forward Ohio —Cleveland, OH
- $55,000 - $62,000 a year
- Temporary
- Mid-level
- Office
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Branch Maintenance Director
YMCA of Central Stark County —Uniontown, OH
- From $44,000 a year
- Full-time
- Computer literacy
- Mid-level
- Recruiting
- Disability insurance
- Health insurance
Quick Apply
Plant Operations Director
Confidential —Cleveland, OH
- $30 - $32 an hour
- Full-time
- Carpentry
- Maintenance
- English
Quick Apply
Maintenance Director
Avenue at Aurora —Aurora, OH
- Full-time
- Skilled nursing facility
- Inpatient
- Mid-level
Quick Apply

I want to receive the latest job alert for director, utilization management & operational integrity in copley, oh

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

director, utilization management & operational integrity jobs near copley, oh

Director Of Operations jobs in Cleveland, OH

Materials Engineer jobs in Cleveland, OH

Regional Director jobs in Cleveland, OH

Director Of Facilities jobs in Cleveland, OH

Medical Director jobs in Akron, OH

Director Of Nursing jobs in Akron, OH

Director Of Marketing jobs in Cleveland, OH

Director jobs in Massillon, OH

Director Of Business Development jobs in Carmel, IN

Business Development Representative jobs in Atlanta, GA

Director Of Business Development jobs in Baltimore, MD

Chief School Business jobs in Illinois

Director Of Business Development jobs in Brunswick, GA

Business Operations jobs in Los Angeles, CA

Director Of Business Development jobs in Jasper, IN

Admissions Director jobs in Willingboro, NJ

Funeral Director jobs in Texas

Executive Director jobs in Tallahassee, FL

Admissions Director jobs in Phoenix, AZ

Admissions Director jobs in Pennsylvania

Director, Utilization Management & Operational Integrity

Medical Mutual of Ohio -
Cleveland, OH

Apply Now

Job Details

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Gym membership

Qualifications

RN License
Managed care organization experience
Utilization management
Bachelor of Science in Nursing
Bachelor's degree in nursing
Clinical confidentiality policies
Project leadership

Full Job Description

Medical Mutual employees must submit their applications through MySource.

Note: This is a hybrid role based in Brooklyn, OH, requiring four days per week on-site.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Directs operations related to Commercial and Medicare acute and post-acute care services to advance evidence-based policies, protocols, and practices to ensure efficient use of health care services and adherence to corporate and regulatory standards. Directs education, training, and auditing of all clinical services and operational staff.

Responsibilities:

Analyzes trends and identifies/implements departmental initiatives based upon data provided through the reporting of production, quality, financial and audit data.
Optimizes processes and workflows to achieve successful quality outcomes and benefit maximization.
Leads the oversight and management of key performance indicators and monitors and tracks to independently identify over/under utilization patterns and/or deviation from expected results.
Develops and implements utilization targets and drives accountability to benchmark metrics for staff productivity and membership management
Oversees the onboarding, education, training, and ongoing monitoring of all Clinical Services & Operations staff, ensuring appropriate decision-making, application of criteria, documentation, and adherence to all regulatory requirements across all lines of business.
Oversees the recruiting, performance, development and mentoring of staff.
Ensures that team members are clinically competent and adequately trained to apply medical necessity criteria.
Provides leadership and support to managers and supervisors.
Ensures monitoring and tracking tools are in place to adequately link and assess production and quality driven work products and outcomes to individual performers.
Leads talent management activities to develop and cultivate future leaders.
Oversees the implementation of processes and systems to improve the efficiency and effectiveness of utilization management for inpatient services.
Develops effective relationships with key health systems to improve communication, efficiency and effectiveness of utilization review process including leading clinical meetings to facilitate relationship building and identifying opportunities to advance access to EMRs/Portals.
Serves as the subject matter expert liaison for acute and post-acute service and/or leader on cross-functional teams.
Initiates cross functional/departmental discussions and initiatives to remove barriers and improve communications and workflows.
Develops formal policies, procedures and workflows that effectively guide quality of work.
Performs other duties as assigned.

Qualifications:

Education and Experience:

Bachelor of Science in Nursing required. Master’s degree preferred.
8 years progressive experience in managed care utilization management, 5 years of which are in a leadership or project management capacity.
Experience with process improvement techniques preferred.

Professional Certification(s):

Registered Nurse with current unrestricted license in state of residency required.
Ability to obtain Ohio RN or Multi-state RN Compact License within 60 days of date of hire.
Ability to obtain additional RN licensure for multi-state member management within 90 days of hire.

Technical Skills and Knowledge:

Comprehensive knowledge of NCQA accreditation standards and CMS regulations, HIPAA compliance and the ability to apply advanced concepts to Company operations.
Strong computer skills (Microsoft Office, including Outlook, Excel, PowerPoint, Word).
Demonstrated success with improving achieving productivity for authorization requests.
Strong demonstrated communication and presentation skills.
Strong knowledge of clinical claim management including ICD 10, CPT and HCPCS codes.
Strong knowledge of health insurance benefits and network plan designs.
Abiltiy to apply knowledge of health plans and industry trends to achieve positive outcomes.
Thorough understanding of clinical knowledge, members’ specific health plan benefits, and efficient care delivery processes.
Knowledge of care delivery systems and continuum of acute through post-acute care.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.

Excellent Benefits and Compensation:

Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-SC1 #LI-HYBRID

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Apply Now

Refine Your Search

director, utilization management & operational integrity jobs in copley, oh

Director, Utilization Management & Operational Integrity

HOSPICE MEDICAL DIRECTOR - Palliative Care (JC432)

Director of Planning

Director of Engineering

Social Services Director

Director of Pharmacy (DOP)

Early Childhood Program Director

Admissions Director

Director of Operations

Director of Marketing

Assistant Director of Nursing (ADON)

Director of Plant Operations

Children's Ministry Director

Director of Business Development

Director of Business Development

Maintenance Director - Long Term Care Facility

Regional Field Director

Branch Maintenance Director

Plant Operations Director

Maintenance Director

I want to receive the latest job alert for director, utilization management & operational integrity in copley, oh

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected