Program Manager, Utilization Management

HealthPartners is hiring a Program Manager, Utilization Management. The Program Manager is responsible for the development and implementation of activities related to utilization management and prior authorization programs for delegated vendors, existing program enhancements and new program identification and implementation. This position is responsible for facilitating and coordinating business relationships with vendors and internal partners. The position is also responsible for providing clinical and operational support to the utilization management team as needed and directed.

MINIMUM QUALIFICATIONS:

Education, Experience or Equivalent Combination:

• Bachelor's degree in nursing, business or health care field.
• Minimum of 6 years experience in a health care environment including previous direct experience in program development.

Licensure/ Registration/ Certification:

• Registered Nurse with current unrestricted license in the State of Minnesota.
• License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.

Knowledge, Skills, and Abilities:

• Strong understanding of managed care and medical management programs.
• Proven ability to develop and implement strategic initiatives using market analytics and competitive insights.
• Demonstrated leadership in project management, including the ability to influence stakeholders and drive results.
• Excellent analytical, problem-solving, and strategic thinking skills.
• Effective communicator with strong presentation and consulting skills; able to engage with all levels of leadership, clinicians, vendors, and customers.
• High level of initiative, adaptability, and comfort with ambiguity and change.
• Proven ability to effectively use personal computer applications such as Word, Excel and PowerPoint.

PREFERRED QUALIFICATIONS:

Education, Experience or Equivalent Combination:

• Bachelor of Science in Nursing, (BSN) preferred.
• Master's degree in business, healthcare administration, or current enrollment in a related master's program.
• Knowledge, Skills, and Abilities:
  
  
  
  • Leads relationships with delegated vendors ensuring program effectiveness.
  
  

ESSENTIAL DUTIES:

(30%)Vendor Relationship Management

• Identify and implement enhancements to existing utilization management vendor programs.
• Maintains awareness of regulatory and accreditation compliance of vendor programs and processes. Immediately take action to address any gaps or potential gaps in compliance or adherence to expectations.
  
  

(20%) Program Evaluation and Performance Metrics

• Develop and maintain performance metrics and scorecards for UM programs.
• Evaluate new initiatives for feasibility, ROI and impact on satisfaction and care quality.

(15%) Market Research and Innovation

• Research market trends, explores strategies, and proposes innovations to advance HealthPartners' utilization management capabilities that optimize health, experience, and affordability for members and patients.
• Creates and builds new models/innovative solutions/pilots for affordability initiatives, employer, and purchaser requirements.
  

(15%) Cross-Functional Collaboration

• Closely collaborates and coordinates with key partners, such as CCA leadership, Improvement and Integration, Health Informatics, and Care Delivery to respond to customer, member, provider, and internal partner requests.
• Provides presentations and training, internal and external to the organization, as needed and appropriate to implement programs, present results, assist sales, and meet customer needs.

(15%) Strategic Alignment and Other Duties

• Ensures program alignment with the strategic direction of Health and Care Engagement.
• Performs other duties as assigned.
  
  
  
  • Manage major projects from planning through execution, coordinating resources, timelines, and stakeholder input to ensure successful outcomes.
  
  

(5%) Project Management

• Ensures key stakeholders are involved, and develops recommendations based on collective input, observations and analysis.