Offer summary

Qualifications:

Bachelor's Degree required, Master's Degree in Nursing, Hospital Administration or related field required, Registered Nurse with 3 years of inpatient experience, Minimum of 5 years management experience in a health-related field, with 3 years in quality management..

Key responsabilities:

Accountable for the success of the Included Health UM program

Oversee program management and coordinate with internal and external resources

Establish and maintain communication with key stakeholders

Serve as a final escalation point for workflow questions and complex cases.

Job description

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com.

In partnership with Senior Leadership, the Utilization Management (UM) Director sets a 2-3 year strategic vision for Included Health's UM service line. This individual will oversee all Include Health UM initiatives and act as the company's UM subject matter expert. This requires someone who is a strong collaborator, excels at stakeholder relationships, is highly organized, and is a self starter.

As the UM leader, the role will also represent Included Health in external meetings with prospective and current clients, and with potential partners, representing and expounding upon Included Health's vision of utilization management.

This position will report to the Senior Director, Clinical Products & Services, at Included Health.

Responsibilities

Accountable for the success of the Included Health UM program

Program management of the UM program with dotted line oversight of the UM RN lead

Exceptional coordination with internal and external resources to develop, build and execute the utilization management program

Establishing and maintaining excellent communication and relationships with key cross-functional stakeholders

Ensuring internal and external workflows are efficient and up-to-date

Partnering closely with key stakeholders in Care and Case management (CCM) as well as member care operations to deliver an exceptional member experience in UM operations

Serving as a final escalation point for workflow questions/clarifications and complex cases

Displaying focus towards continuous improvement, pilots alternative solutions that improve team productivity, workflows, member experience, and efficiency aligning directly with our company values and goals

Designing and implementing a quality review process for UM both internally and externally

Responsibilities may shift over time depending on CCM and/or UM program needs

Able to work Monday-Friday 8AM to 5PM local time

Basic Qualifications

Bachelor's Degree required

Master's Degree in Nursing, Hospital Administration or related field required

Registered Nurse, in good standing with current state of licensure and with 3 years of experience as inpatient RN

A minimum of 5 years of management experience in a health-related field, along with 3 years of experience in a quality management position

Previous quality and workflow management experience required

Excellent organizational skills and attention to detail required

Data-driven and comfort in using tools to evaluate and optimize the standardization of care across our growing team

Ability to be agile and balance multiple priorities while maintaining positive and professional attitude

Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbalStrong ambition and internal drive is essential to this position

Strong ambition and internal drive is essential to this position

Preferred Qualifications

Project management experience preferred

Previous Case/Care Management experience a bonus

Physical Requirements

Prompt and regular attendance at assigned work location

Ability to remain seated in a stationary position for prolonged periods

Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment

No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required

Ability to interact with leadership, employees, and members in an appropriate manner.

This position requires frequent communication with patients and physicians; must be able to exchange accurate information during these patient encounters

Occasional overnight business travel

The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. FInally, this job description is not intended in any way to create a contract of employment.

The United States new hire base salary target range for this full-time position is: $118, 640 - $167,580 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry.

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