R.A. Wylan & Co. Inc.,
Career Center

Senior Director, UM (RN

Location: Columbus, OH
Job Type: Direct Hire
Degree: Bachelor;
Date: 2/14/2018
Job ID: 02559491
Job Description
Senior Director, UM (RN)  – COLUMBUS, OHIO

Take your career to the next level with this innovative health plan.

Very visible role participates in senior leadership meetings, engages with providers in the community, and interacts directly with OH Department of Medicaid. 

- GENEROUS relocation- strong data analytic support – solid leadership

Senior Director will oversee all UM operations for the OH market, working across all product lines. Define and direct the case management program for the plan in conjunction with corporate goals and objectives.
-  Evaluate UM program effectiveness and recommend improvements, including needs analysis and planning
- Ensures provider satisfaction with UM program
- Ensure UM targets for all products are met for the annual operating plan, state requirements and financial management. 
-  Ensure that UM process is integrated with case management program
- Maintain compliance with NCQA standards for case management function.
-  Develop and implement methods, policies and procedures to improve the department’s efficiency and effectiveness.
-  Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting
- Review various reports and identify trends to assist in financial forecasting


-Strong leadership skills with a passion for mentoring and developing teams.
- Bachelor's degree in nursing, related field, or equivalent experience.

-7+ years of UM, clinical nursing and quality improvement experience in a managed care setting.

- Current state’s RN license (or willing to obtain)

Not a remote position.