SWHRCIN VP Utilization Mgt SWHR CIN
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Professional Experience/Qualifications:
Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions. This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner and self-starter. Comfortable working in complex and matrix organizations. The requirements listed below are representative of the knowledge, skill, and/or ability required to build SWHR's culture for action.
- Bachelor’s degree from accredited college in Nursing, Healthcare Administration or Related Field required.
- RN or NP with current Texas License required
- Master’s Degree from accredited college in Business or Healthcare preferred.
- 10 years’ related experience in case management, utilization review, and/or medical management required.
- 5 years’ experience in management, preferably in complex, matrixed organizations required.
- Broad understanding of UM and associated NCQA accreditation standards
- Experience in case management and utilization reviews
- Knowledge of ACO financial models, health care delivery systems and market dynamics.
- Strong data analytic skills
- Ability to monitor and maintain a budget.
- Ability to effectively interpret and apply organizational policies, procedures, and systems.
- Excellent interpersonal, organizational, supervisory/managerial, and analytical skills.
- Demonstrated ability to manage multiple projects and exercise independently decision-making and problem-solving skills
- Ability to lead committees
- Proficient in Microsoft Office (Excel, Word, PowerPoint)