Bluebonnet Trails Community Services (BTCS) is a leading organization committed to providing high-quality, accessible, and person-centered care to our community. With a focus on innovation and continuous improvement, we strive to enhance the health and well-being of individuals and populations we serve. We are dedicated to promoting positive health outcomes through effective utilization management and population health strategies.
We are seeking an accomplished and passionate professional to join our dynamic team as the Utilization Management (UM) Director. This highly skilled and experienced candidate will have experience with utilization management and population health. As the UM Director, this candidate will play a pivotal role in overseeing and implementing utilization management and population health initiatives to optimize care and promote efficient resources utilization.
The UM Director reports to the Utilization Management Quality Management (UMQM) Director. This is a senior-level position in the UMQM Department and is instrumental in improving the health and wellness of persons served at BTCS by managing data that informs treatment strategies and interventions for the population. This position is responsible for data collection, analysis and making recommendations for improving health outcomes as well as identifying potential training needs for staff, as it relates to utilization management and population health. While leading a team of utilization management and population health professionals, this candidate will evaluate and analyze utilization trends, patterns and outcomes to identify opportunities for improvement and develop actionable strategies.
This candidate will oversee the utilization management functions at BTCS. This includes, but is not limited to, utilization reviews, ensuring compliance with regulatory requirements, risk stratification, state contract management with oversight of report submission, state contract metric monitoring and oversight, PPB reauthorization, financial monitoring, oversight of batch reporting, encounter set up, report oversight from state systems, and data entry.
Furthermore, this candidate will oversee the population health teams focusing on the Community Strengths and Needs Assessment, grant evaluation, DPP-BHS reporting, CCBHC measures, Alternative Payment Model measure oversight, measure development, report and data validation, as well as new population health initiatives.
In addition to the management responsibilities, this candidate will play a vital role in facilitating meetings and actively participating in clinical and administrative teams to foster a culture of continuous quality improvement. This position works under limited supervision, with considerable latitude for the use of initiative and independent judgment.
Location: Round Rock and Remote
Why join our team?
BTCS Values our team members and believes it is important to reward and compensate our team members for their contribution to our success. BTCS offers competitive salaries, an excellent benefits package and generous leave accruals.
Medical Insurance: Through BlueCross Blue Shield, we offer comprehensive medical coverage for you and your eligible dependents with access to network and non-network health care providers. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.
Dental Insurance: Through Dental Select, we offer two coverage plans for dental care, to include preventative, basic and major services. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.
Vision Insurance: Through BlueCross BlueShield, we offer vision coverage to include discounts on everyday vision needs, such as eye exams and glasses and/ or contacts. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.
Prescription Plan: Through BlueCross BlueShield, we offer discounts on generic, preferred or brand-name drugs as well as non-preferred drugs at pharmacies or through a convenient home delivery program. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.
Flexible Spending Accounts: Optional pre-tax contributions for medical reimbursement and dependent care plans.
Family and Medical Leave: Job protection to provide care related to a child’s birth or adoption, or for yourself or a family member’s serious health condition.
Employee Assistance Program: Through Alliance Worksite Solutions, we offer a no cost, confidential employee assistance program as a resource to resolve personal, family, financial and legal problems for employees and their dependents.
Professional Development: Joining Bluebonnet Trails is about joining a culture of inclusiveness, collaboration, trust, and the invitation and expectation to have a voice. Bluebonnet offers employees the opportunity to participate in professional development that is skill based and offers continuing education courses to enhance knowledge and performance via online courses and instructor led webinars.
|City||Round Rock, Remote|
|Credentials||Minimum Qualifications: Graduate degree in relevant clinical, social sciences, public health, or healthcare administration is required |
Is license to practice in the State of Texas within 6 months of hire as a: Physician; Registered nurse or a Registered Nurse- Advanced Practice Nurse; Physician Assistant; Licensed Clinical Social Worker; Licensed Professional Counselor; Licensed doctoral level Psychologist; or Licensed Marriage and Family Therapist
5+ years of experience in a community health setting
Excellent written and verbal communication skills
Ability to lead and facilitate group processes
Demonstrated competence in performing UM and review activities
Knowledge of population health strategies
Ability to analyze and interpret data
Ability to produce documents in Excel, Word, PowerPoint
Preferred Qualifications: 5+ years of experience in project management and/or management roles
Knowledge of BTCS’s state contracts and the Texas Administrative Code (TAC), and their alignment to BTCS’s programs.
Strong background in and experience with quality management in a healthcare setting.
Extensive experience with Texas 1115 Medicaid Waiver and National Measures
Extensive knowledge of CCBHC.
Experience with Texas Community Mental Health Centers and population health outcome measures.
Experience with enterprise-wide clinical data systems and electronic medical records
Experience and skills with MS-SQL Server and/or report writing and development skills
|Closing Date||Open until filled|