Utilization Management Director (UM/CCM)

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

In partnership with Senior Leadership, the Utilization Management (UM) Director sets a 2-3 year strategic vision for Included Health’s UM service line. This individual will oversee all Include Health UM initiatives and act as the company’s UM subject matter expert. This requires someone who is a strong collaborator, excels at stakeholder relationships, is highly organized, and is a self starter. 

As the UM leader, the role will also represent Included Health in external meetings with prospective and current clients, and with potential partners, representing and expounding upon Included Health’s vision of utilization management.

This position will report to the Senior Director, Clinical Products & Services, at Included Health.

Responsibilities

• Accountable for the success of the Included Health UM program
• Program management of the UM program with dotted line oversight of the UM RN lead
• Exceptional coordination with internal and external resources to develop, build and execute the utilization management program
• Establishing and maintaining excellent communication and relationships with key cross-functional stakeholders 
• Ensuring internal and external workflows are efficient and up-to-date
• Partnering closely with key stakeholders in Care and Case management (CCM) as well as member care operations to deliver an exceptional member experience in UM operations
• Serving as a final escalation point for workflow questions/clarifications and complex cases 
• Displaying focus towards continuous improvement, pilots alternative solutions that improve team productivity, workflows, member experience, and efficiency aligning directly with our company values and goals
• Designing and implementing a quality review process for UM both internally and externally

Responsibilities may shift over time depending on CCM and/or UM program needs 

Basic Qualifications

• Bachelor’s Degree required
• Master’s Degree in Nursing, Hospital Administration or related field required
• Registered Nurse, in good standing with current state of licensure and with 3 years of experience as inpatient RN
• A minimum of 5 years of management experience in a health-related field, along with 3 years of experience in a quality management position
• Previous quality and workflow management experience required
• Excellent organizational skills and attention to detail required
• Data-driven and comfort in using tools to evaluate and optimize the standardization of care across our growing team
• Ability to be agile and balance multiple priorities while maintaining positive and professional attitude
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbalStrong ambition and internal drive is essential to this position
• Strong ambition and internal drive is essential to this position

Preferred Qualifications

• Project management experience preferred
• Previous Case/Care Management experience a bonus

Physical Requirements

• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner.
• This position requires frequent communication with patients and physicians; must be able to exchange accurate information during these patient encounters
• Occasional overnight business travel




The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. FInally, this job description is not intended in any way to create a contract of employment.

The United States base salary range for this full-time position is $145810 AND $175000 + equity + benefits + leadership bonus potential.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Included Health reserves the right to modify these ranges in the future. For further information, please ask your Recruiter. 

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following: 

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents 

Generous Paid Time Off ("PTO") and Discretionary Time Off (“DTO")

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment) 

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work 

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

#LI-REMOTE #LI-SK1

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.