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

This is an on-site role and requires relocation to the San Antonio, TX area. Our Company offers full relocation for this role.

Job Summary:

The Director, Operations (Utilization Management or UM) 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. This 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. Essential Job Functions

• 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 budgets for assigned activities in accordance with the budget procedure
• Provides orientation and on-the-job training for subordinates and ensures that the authority and responsibility for each position are defined and understood
• Ensures that the duties, responsibilities, authority, and accountability of all direct subordinates are defined and understood
• Assumes other activities and responsibilities from time to time as directed

Knowledge and Abilities Requirements:

• Current knowledge of utilization review processes and managed care
• Knowledge of or ability to learn financial management related to UM function and reporting, quality improvement processes, and human resources management
• Ability to effectively monitor, evaluate, and administer the resources of each assigned area and make substantiated recommendations regarding resource allocation needs for future planning purposes
• Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
• Ability to communicate those trends found through analytical study using a variety of reporting mediums
• Experienced in building and leading high-performing teams through effective recruitment, training, and motivation, aligning staffing strategies with profitability and growth objectives
• Excels in building and sustaining strong professional relationships through a poised demeanor and assertive communication style that is both respectful and collaborative
• Strong technical sourcing abilities and experience with a fast-growing start-up company are a plus
• Demonstrated ability to problem-solve complex, multifaceted situations
• Ability to engage easily in abstract thought
• Keen sense of urgency, exceptional organizational skills, and the ability to prioritize tasks in a fast-paced environment
• Strong analytical, numerical, and reasoning abilities
• Participative management type (advocates team concept)
• Demonstrates exceptional judgment and quickly identifies optimal solutions, aligning with business objectives
• Ability to train, mentor, and motivate team members and have excellent collaborative skills
• Communicate effectively (both verbally and in writing) with administrators, co-workers, and other personnel when providing information and/or services
• Establish a team-oriented, efficient, and effective work environment
• Responsible for the performance management review process for all direct reports
• Hold regularly scheduled meetings with team members to keep them informed, motivated, and review/streamline processes, as well as discuss opportunities and concerns
• Ability to make recommendations for practice change to improve the Utilization Management efforts of the department
• Ability to represent Utilization Management in organizational committees as assigned
• Excellent relationship management skills
• Ability to establish credibility and be decisive
• Able to recognize and support the organization's preferences and priorities
• Results-oriented with the ability to balance other business considerations
• Knowledge of multi-state workers' compensation systems
• Computer literacy on Microsoft Office products and database programs
• Ability to construct grammatically correct reports using standard medical terminology

Education and Experience:

• Bachelor's Degree (or equivalent work experience)
• Minimum of 3 years as a Director in a Utilization Management (UM) organization

License and Certification:

N/A Driving Essential:

No Position Demands:

This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information. Equal Employment Opportunity (Our EEO Statement): The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated. We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Health savings account Life insurance Paid time off Professional development assistance Referral program Relocation assistance Vision insurance

Education:

Bachelor's (Preferred)

Experience:

Dir. level Utilization Mgmt. (medical or Insurance) org.: 3 years (Required) Ability to

Relocate:

San Antonio, TX 78154: Relocate with an employer provided relocation package (Required)

Work Location:

In person