Utilization Management Director jobs in Boca Raton, FL

100% remote.

JOB SUMMARY

Oversee and ensure the overall profitability of the regional operations center. This includes but is not limited to reaching and exceeding financial & referral goals, properly managing staffing efficiencies throughout the team, managing performance expectations & improvements for existing staff. Present management with regular reporting on any topic requested by the management team.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Driving Revenue Growth

• The Operations Manager drives revenue growth by delivering excellent Customer service.
• This includes meeting scheduling best practices and turnaround time requirements.
• Ensuring the timely delivery of high quality reports.
• Managing client inquiries in a timely manner.

Optimizing Physician cost

• Ensuring that client invoices adhere to the agreed upon fee schedule.
• Overseeing the proper selection of physicians.
• Specifically ensuring that the team selects the most appropriate physician based on the claimant’s location, the required specialty, and the most appropriately priced physician based on the client’s fee schedule.
• Building relationships with key physicians to ensure panel retention.

Manage Staff Performance and capacity

• Monitor key performance metrics of individual Customer Service Representatives (CSR) and Quality Assurance (QA) Specialists.
• Ensure the team meets or exceeds 85% of output goals for scheduling and Quality Assurance targets.
• Responsible for hiring new staff members based on increased referral volume and/or the addition of new clients.
• Conducts performance evaluations that are timely and constructive.
• Handles discipline and termination of employees as needed and in accordance with company policy.

Client Interaction

• The Operations Manager may be requested to join the Sales staff for client visits on an as needed basis.

Responsible for the overall production, performance, and quality of the assigned region.

• Plans and organizes daily activities related to production and operations.
• Measures productivity by analyzing performance data, financial data, and activity reports.
• Coordinates with other support departments such as human resources, finance, and IT and BA to ensure successful production operations.
• Determines labor needs to meet production goals.

Oversee the deposition process at the request of the client or defense counsel.

Other duties & special projects, as assigned and based on business needs.

EDUCATION/CREDENTIALS:

• An Associate’s Degree or Bachelor’s Degree is preferred.
• RN / LPN License is required.

JOB RELEVANT EXPERIENCE:

• Business experience in a healthcare and/or insurance setting is preferred.
• Business experience in a Clinical setting is preferred.
• Utilization Review experience is required.

JOB RELATED SKILLS/COMPETENCIES:

• Present exceptional communication skills with a clear understanding of company business lines.
• The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

• Supply and support their own internet services.
• Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.