Director, Utilization Management

Who We Are: 

Herself Health is an Advanced Primary Care provider for women 65+ enrolled in Medicare and Medicare Advantage plans. The concept was born out of a need to significantly improve the delivery and quality of primary care provided to this population and solve common challenges with the delivery of healthcare today, such as long wait times, rushed appointments, and care that is generalized, rather than personalized. We have a focus on women’s issues later in life (bone loss, weight fluctuation, changes in mental, social and emotional health). The concept and development of this company has been led by a successful venture-backed team and board with a well established record of building “best-in-class” companies. The Twin Cities Metro area of Minneapolis and St Paul, MN is the location for the company’s clinical launch. 

What We Do: 

At Herself Health, we believe in taking a bold approach to the care of women in their most self-defining years. From their mid 60’s, as they age, women may finally have the luxury of time for self-care, self-reflection, and self-discovery. They often find a renewed purpose in life and can truly tap into the wellspring of wisdom and resilience they have built, allowing them to live their lives as fully as they aspire. We believe that trusted relationships are nurtured through effective communication and a sense of enduring connection. As healthcare providers, we strive to be our patients’ most trusted partners in their unique journeys through life. Our whole-person approach involves caring equally for the mind and body, while staying anchored in the value of “what matters most” to each individual.  

We use a team approach to care. As a highly trained and experienced group of professionals, we delight in working closely with each other, our patients, their loved ones, families, and caregivers. We work hard to maximize overall wellness, preserve function, optimize health, and help each woman age with dignity and grace. Our team of experts aims to elevate our patients’ experience of healthcare by providing evidence-based, whole-person, coordinated, timely, cost effective, and values-centric care. We espouse a joyful, respectful, non-discriminatory, and non-judgmental approach to every interaction, whether with our patients or among ourselves. 

The Director of Utilization Management Role: 

The Director of Utilization Management reports to the VP of Clinical Ops in the interim and is a key leadership role responsible for building Herself Health’s This role is primarily focused on one of the key pillars of our business, managing medical costs and providing valuable care to the patients. 

Core Responsibilities: 

Ops Design and Implementation 

• Establish initial processes for care management with a path to Care Management (delegated) under a risk arrangement, such as acuity/disease based programming (diabetes, COPD, etc.) 
• Establish processes for utilization management such as avoidable hospital admissions an and specialist admits, etc. 
• Develop strategy for expanding our interdisciplinary care team to include a concierge or social work type role
• Partner with regional heads of clinical operations to ensure thorough and safe practice operations for running our brick and mortar locations
• Design and implement Health Coach Program:
• Identify and reach out to target list of members to help close care gaps
• Identify and help close SDOH gaps
• Help build out and manage the Health Coach team
• Improve NPS
• Work with team to develop a way to stratify population 

Must have experience:  

• Experience in consulting, strategy and/or partnerships or key account management 
• Undergraduate degree 
• Experience setting strategy and executing partner/key account development plans 
• Demonstrated strength in process/project management and comfort with data analysis 
• Demonstrated creative and unconventional approaches to building new growth sources; strategic thinker who can “tie it all together”
• Excellent interpersonal skills, ability to gain rapport quickly with VP level stakeholders in partner organizations
• US work authorization 

Nice to have experience:  

• Experience in value-based care organizations 
• Experience in Medicare Advantage 

We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discriminate on the basis of race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws