Senior Manager Of Utilization Management

Hennepin Health is looking for a Senior Manager to lead the Utilization Management team. Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Our mission is to help people improve their health through innovative collaborations. This position is responsible for a wide range of health plan program initiatives and activities that support the provision of health care, including evaluating the appropriateness of health care services; promoting high-value health care, and utilizing care management tools to improve clinical outcomes for members. The Senior Manager of Utilization Management has accountability for developing clinical program strategic goals, performance standards, and objectives in collaboration with the Chief Medical Officer and the Director of Clinical Services.

This position will coordinate clinical program initiatives and activities by working collaboratively with other areas of Hennepin Health, including claims processing, quality management, care management, finance, information technology, analytics, and provider operations. They are responsible for completing relevant portions of the Utilization Management Work Plan and evaluation, as well as standardizing and implementing Hennepin Health Utilization Management procedures in compliance with state and federal regulatory requirements. Additionally, this position represents Hennepin Health on various committees at the state and county level.

Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit theemployee referral program page.
Location and hours:
This position is hybrid and will be performed both remotely and on-site at 525 Portland Avenue South, Minneapolis, MN as job duties require. Work hours will be Monday through Friday, between 8 a.m. - 4:30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin.
About the position type:
This is a full-time, benefit-earning position.
This position is internally classified as an Administrative Manager, Senior. Click here to view the job classification specification.

Note: You must attach a resume as part of your application materials to be considered for this position.

In this position, you will:

• Oversee the development and execution of Utilization Management program goals and objectives including the service authorization process, clinical aspects of the restricted recipient program to meet Department of Human Services (DHS) contractual and Hennepin Health operational requirements, improve member health outcomes, and maintain compliance with policy guidelines, external regulatory requirements, accreditation standards, and industry best practices.
• Develop clinical policies, implement DHS annual contract updates and prior authorization requirements for technical and personnel resources that ensure compliance with DHS contractual requirements for Utilization Management at both the state and federal level. Conduct routine audits including participation in fraud, waste, and abuse investigations to ensure that the Utilization Management program and contracted providers meet these requirements.
• Provide leadership that contributes to a positive workplace culture; supervise staff, develop and implement training on regulatory requirements; establish standards for quality of work and evaluate employee performance.
• Provide leadership to further department-based strategies that align with county goals, mission and core values for diversity, equity and inclusion.
• Coordinate data analytics and outcome reporting for Utilization Management and prior authorization services.
• Develop, execute, and evaluate clinical components of Hennepin Health strategic direction to drive innovation, improve clinical outcomes, and optimize care management system integration.

Need to have:
One of the following:

• Bachelor's degree in nursing, social work, public health, business administration or other field appropriate to the position and five years of experience in Utilization Management and the administration of organizational operations.
• Nine years or more of experience in Utilization Management and the administration of organizational operations.

About the department:
Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well being of our members and the community.
About Hennepin County:
Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align to one or more of our overarching goals -- that Hennepin County residents are healthy, protected and safe, self-reliant, assured due process, and mobile.
Our employees receive a combination of generous benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (login as Guest).
Hennepin County envisions an organization where our commitment to diversity and the reduction of disparities is fundamental in providing excellent service to our community.
Your future. Made here.
This posting may be used to fill current and future vacancies.
This position will have access to systems or other documentation that contains HIPAA data.
Invitations to interview will be based upon an assessment of education and experience. Final candidates will be required to pass a background check.
If you have any questions, please contact:
Brooke Haaf
Brooke.Haaf@hennepin.us Employment Type: Full-time