Director, Operations
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Job Description
Director overseeing utilization review and IRO operations for Nexus Enterprises and ProPeer Resources. Managing teams, budgets, compliance, quality improvement, and operational performance.
Responsibilities:
- Work closely with the VP, Operations to position the organization and subsidiaries for ongoing organizational change
- Direct the daily administrative workflow for Nexus Enterprises, LLC and ProPeer Resources, LLC
- Oversee daily operations and supervise the operational management team
- Ensure staff performance across the Utilization Review and Independent Review Organization business lines
- Drive clinical, financial, and utilization goals through effective management and role modeling
- Manage financial, human resources, leadership, quality, and operational objectives
- Participate in program development and unit performance improvement
- Review performance against operating plans and standards and provide reports
- Present monthly and ad hoc performance reports
- Develop objectives, plans, processes, programs, budgets, and financial estimates for Operations
- Coordinate and collaborate with other departments and management
- Review operational projects involving major organizational changes
- Plan new technology areas supporting the operational function and organizational mission
- Establish objectives and processes for assigned activities and review Operations Management Team objectives
- Select, retain, train, and develop qualified personnel
- Manage human resources utilization, staff satisfaction, development, and progressive discipline
- Ensure workflow completes client-specified work according to specifications
- Participate in quality improvement and regulatory standards implementation
- Research interdepartmental problems and take corrective action
- Establish, evaluate, and monitor Utilization Review processes, policies, and procedures
- Support company and departmental QA/QI initiatives
- Maintain communication with team members, departments, management, and external departments
- Ensure compliance and recommend policy and procedure improvements
- Review, revise, and submit budget proposals
- Provide orientation and on-the-job training
- Define and communicate direct-report duties, responsibilities, authority, and accountability
- Perform additional activities and responsibilities as directed
Requirements:
- Current knowledge of utilization review processes and managed care
- Knowledge of, or ability to learn, financial management related to Utilization Management functions and reporting
- Knowledge of quality improvement processes and human resources management
- Ability to monitor, evaluate, and administer resources and recommend resource allocation
- Ability to identify trends through practice analysis to improve resource utilization and cost containment
- Ability to communicate analytical trends through varied reporting mediums
- Experience building and leading high-performing teams through recruitment, training, and motivation
- Strong professional relationship-building and assertive, respectful communication skills
- Strong technical sourcing abilities and fast-growing start-up experience are a plus
- Demonstrated ability to solve complex, multifaceted problems
- Ability to engage in abstract thought
- Keen sense of urgency, exceptional organization, and prioritization in a fast-paced environment
- Strong analytical, numerical, and reasoning abilities
- Participative management style and team-oriented approach
- Exceptional judgment and ability to identify optimal business-aligned solutions
- Ability to train, mentor, motivate, and collaborate with team members
- Effective verbal and written communication with administrators, coworkers, and other personnel
- Ability to establish an efficient and effective team-oriented work environment
- Responsible for performance management reviews for all direct reports
- Ability to recommend practice changes to improve Utilization Management efforts
- Ability to represent Utilization Management on organizational committees
- Excellent relationship management skills
- Ability to establish credibility and make decisive decisions
- Ability to support organizational preferences and priorities
- Results-oriented ability to balance business considerations
- Knowledge of multistate workers’ compensation systems
- Computer literacy in Microsoft Office products and database programs
- Ability to construct grammatically correct reports using standard medical terminology
- Bachelor’s Degree or equivalent work experience
- Minimum of 3 years as a Director in a Utilization Management or Utilization Review organization
- No license or certification required
- Driving is not essential
- Ability to sit, bend, and stoop 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
- Ability to operate a computer, calculator, copy machine, printer, and other office productivity machinery
- Ability to frequently communicate and exchange accurate information with guests, team members, and vendors
Benefits:
- Equal Employment Opportunities to all Team Members and applicants
- Inclusive environment for all Team Members and applicants
- Veterans are encouraged to apply
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