Utilization Management Market Operations Manager - RN Preferred - Must live in Nevada - Must hold NV license

Education and Experience:

• Associates degree in Nursing or advances degree is Psychology is required
• A minimum of five (5) years of experience in UM or related operations related to the responsibilities of this position is required
• Managed Care experience is required
• Experience with analysis, data and reporting is required
• Accreditation, auditing, and process improvement experience is preferred
• Demonstrated change management and continuous improvement leadership skills required
• Previous experience with quality control and/or process standards preferred
• Competencies, Knowledge and Skills:
• Proficient use of Microsoft Office Suite, to include Word, Excel, PowerPoint, Outlook, and Visio knowledge with a strong willingness to learn
• Fluent in NCQA and/or CMS, accreditation and audit standards with knowledge of regulatory reporting, compliance requirements, and auditing procedures
• Decision making/problem solving and critical thinking skills
• Planning, problem identification and resolution skills
• Strong oral, written and interpersonal communication skills
• Responsive to a changing environment/change resiliency
• Proficiency with quality improvement, performance improvement and operations
• Ability to develop, prioritize and accomplish multiple competing goals
• Strong collaboration skills with ability to work with multi-disciplinary departments
• Ability to work independently and within a team
• Strong attention to detail and time management skills
• Customer service oriented with de-escalation skills
• Ability to gather/analyze data and create meaningful action items
• Ability to review and implement evidence-based trends
• Licensure and Certification:
• Current, unrestricted Registered Nurse (RN) licensure or Licensed Psychologist in state of practice is required
• Six Sigma or project management certifications are a plus
• Working Conditions:
• General office environment; may be required to sit or stand for extended periods of time
• Compensation Range:
• CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
• Compensation Type (hourly/salary):
• Organization Level Competencies
• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business
• This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.