Director of Transitional Care & Utilization Management

Director of Transitional Care & Utilization Management

AbsoluteCare is currently seeking a highly skilled and motivated Director of Transitional Care & Utilization Management to join our team in Ashburn, VA. As a leading provider of comprehensive care, we serve vulnerable individuals who are at higher risk for disease or have multiple complex chronic illnesses. Our mission is to provide care beyond medicine and deliver the best, most focused care possible to our members.

Job Summary:

The Director of Transitional Care & Utilization Management will be responsible for the development and management of the transitional care program, post-acute interventions, and utilization management programs. This includes implementing clinical interventions and guidelines to reduce unnecessary healthcare resources and prevent preventable admissions/readmissions, complications, and redundant healthcare services. As a key member of our integrated multi-disciplinary team, you will collaborate with care teams, community healthcare professionals, and external stakeholders to proactively manage a vulnerable complex population. This role requires adherence to industry standard clinical guidelines, regulatory standards, and key performance indicators to ensure programmatic outcomes align with our mission and vision.

Duties and Responsibilities:

• Develop transitional care, post-acute, and utilization management program standards, practices, protocols, policies, and procedures
• Leverage evidence-based guidelines for discharge planning and optimize appropriate level of care decisions
• Ensure high quality and timely delivery of care coordination and utilization management
• Lead a transitional care management/utilization management team
• Collaborate with interdisciplinary care team to deliver integrated care
• Analyze data to design and implement processes for positive health outcomes
• Oversee clinical staff development and performance
• Consult on best practices related to staff recruitment and training
• Act as a liaison between the executive team and the care delivery teams
• Collaborate with multi-disciplinary team to further program development
• Direct and coordinate internal and external agents for patient safety and compliance
• Plan and supervise administrative aspects of the department
• Improve reporting and monitoring member engagement and outcomes with data analysis
• Identify barriers within the organization and provide training for other departments
• Oversight and management of NCQA Utilization Management program

Minimum Qualifications:

• Proven record of leading through change in a dynamic organization
• Registered Nurse with preferred Masters level degree
• Minimum of 5 years’ experience leading transitional care management and utilization management programs
• Experience with transitions of care, discharge planning, inpatient clinical care, and/or robust post-acute programs
• Knowledge of care transitions and associated readmission reduction strategies
• Experience with discharge planning and post-acute care management plans
• Proven ability to analyze and leverage population health reporting
• Experience with NCQA and Delegated Utilization Management programs preferred
• Multiple settings experience preferred
• Experience working with vulnerable, high-risk, medically complex patients
• Excellent oral and written communication skills
• Excellent leadership and organizational skills
• Knowledge of electronic medical records and reporting capabilities
• Working knowledge of Microsoft Office Suite
• Ability to travel up to 50%
• Active unencumbered driver’s license and reliable transportation

Working conditions:

This role operates in a community and office environment and may operate in a remote capacity. The Director of Transitional Care & Utilization Management may be required to travel to our comprehensive care centers and inpatient facilities. The role will also routinely use general office equipment and may be exposed to diseases and infections of patients.

Physical requirements:

This position requires constant communication, stationary work for long periods, and operation of computer and office equipment. The Director of Transitional Care & Utilization Management may occasionally be required to move objects up to 20 lbs.

AbsoluteCare, Inc. is committed to providing equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.