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Working Each Day to Make a Difference

At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.

Senior Director, Utilization Management & Transitional Care

This position is a Hybrid position with the option for either full-time in office or hybrid between remote/home and in office as required. It will require periodic meetings in the main office in Seattle. Any candidate located within Washington State is welcome to apply.

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[POSITION PURPOSE:]{.underline}

This role drives vision and strategy for the integrated medical and behavioral utilization management/ transitional care programs, including overall planning, program and budget development, program implementation, and coordination to achieve quality and service-driven objectives.  Oversees all phases of development, organization, planning, and implementation of projects/initiatives/workflows/processes to enhance quality-driven outcomes and ensure programs meet all state, federal and regulatory requirements.

[PRINCIPAL DUTIES:]{.underline}

Oversee the organization's comprehensive utilization management and transitional care strategy. Includes integrated teams performing utilization management functions for physical and behavioral health services.

Leads systematic and comprehensive utilization management program that incorporates intake, clinical review, medical necessity, discharge planning, and post discharge support for physical and behavioral health services, including written policies and procedures that ensure regulatory compliance with State (HCA), Federal (CMS), NCQA and other oversight entities.

Leads transitional care program that incorporates 72-hour post-discharge support and behavioral transitions, including policies and procedures that ensure regulatory compliance with State (HCA), Federal (CMS), NCQA and other oversight entities.

Works effectively across departments to ensure seamless coordination and operational workflows between teams (i.e. care management, claims, appeals)

Shares responsibility for operational oversight of Plan Medical Directors performing utilization review functions, including ensuring schedules meet the needs of the department and processes are established and monitored to support the utilization management and transitional care programs.

Responsible for ensuring effective oversight of UM operations and staff, including working with department leadership to identify staffing and resource needs, ensure effective hiring, engage in appropriate performance management and staff development, with