{"id":3563806,"url":"https://alion.io/job/caresource-um-operations-strategy-implementation-lead","title":"UM Operations Strategy Implementation Lead","company":{"id":2670646,"name":"CareSource","domain":"caresource.com","url":"https://alion.io/company/caresource","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Schema","truth_index":{"grade":"A","score":88,"open_postings":3,"ghost_share":0,"stale_share":0.667,"repost_share":0,"time_to_fill_p50_days":12,"computed_at":"2026-11-01T06:10:25Z"}},"role":"Solutions","role_family":"Solutions","seniority":"lead","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":[],"countries":[],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":83000,"max":132800,"currency":"USD","period":"year","gross":null,"usd_annual":132800},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false},{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-10-30T00:00:00Z","employer_posted_date":"2026-10-31","last_verified_at":"2026-11-01T05:33:08Z","board_verified":true,"closed_at":null,"days_open":2,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":2},"description":"Job Summary:\nThe Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM department. This role will also drive key process changes and identify key gaps and variances across the department.\nEssential Functions:\nUtilize process controls to achieve operational excellence in all areas within the department\nActively work with UM leadership in closing variances of identified risks to compliance\nUtilize process improvement frameworks to drive continuous improvement\nAssess data to identify any misalignment with compliance, regulatory and operational requirements and support process changes that result from any identified opportunities\nCollaborate with analytics, Physical Health and Behavioral Health clinical teams, compliance and regulatory to ensure regulatory content is represented in the data sets and validated\nAssist in implementations of changes through systematic and measurable actions ensuring regulatory, accreditation, and compliance business goals are met\nAssist in the creation of the UM (including Clinical responses) for the NQTL data and narrative submissions\nProactively build and manage various relationships to improve standardization and interdepartmental collaboration on enterprise goals and initiatives\nProvide Clinical and UM support on parity associated internal compliance workgroups\nWork collaboratively with the appropriate departments to define and utilize outcome measurements, and support a culture of compliance\nPartner as needed with other departments to support in the implementation of process improvement opportunities, new business rules, new products and delegations\nSupport change management initiatives that impact the department\nAssist in analysis and recommendations for annual product filings and UM strategy from a parity perspective\nPerform any other job duties as requested\nEducation and Experience:\nBachelor’s degree in healthcare, population health or related field, or equivalent years of relevant work experience is required\nA minimum of five (5) years of experience in UM or related to the responsibilities of this position is required\nPrevious experience with quality control and/or process standards is preferred\nCompetencies, Knowledge and Skills:\nSME in federal/state laws and regulations\nProficient use of Microsoft Office Suite, to include Word, Excel, PowerPoint, Outlook, and Visio with a strong willingness to learn\nAbility to analyze processes across multiple functional areas\nAbility to work independently and within a team environment\nUnderstanding of ROI and risk avoidance\nDemonstrated change management and continuous improvement leadership knowledge\nAbility to gather data and create meaningful analysis\nAbility to review and implement evidence-based trends\nStrong oral, written and interpersonal communication skills\nStrong understanding NCQA and/or CMS, accreditation and audit standards with knowledge of regulatory reporting, and compliance requirements\nStrong attention to detail and time management skills\nEffective problem-solving skills with attention to detail\nEffective listening and critical thinking skills\nLicensure and Certification:\nCurrent, unrestricted Registered Nurse (RN) licensure is preferred\nSix Sigma or project management certifications are preferred\nWorking Conditions:\nGeneral office environment; may be required to sit or stand for extended periods of time\n$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.\nSalary\nOrganization Level Competencies\n- Fostering a Collaborative Workplace Culture\n- Cultivate Partnerships\n- Develop Self and Others\n- Drive Execution\n- Influence Others\n- Pursue Personal Excellence\n- Understand the Business\nThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. 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