Jobs for People with MS: National MS Society

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"}.

Program Manager II, Utilization Management This position is available fully remote within Washington State**

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[POSITION PURPOSE:]{.underline}

The Utilization Management Program Manager collaborates with the utilization management leadership team to develop and monitor utilization management programs across all lines of business, covering physical and behavioral health. This position provides expertise in analytics, reporting systems and project management to ensure that the utilization management program is compliant with regulatory requirements. Supporting the utilization management team involves measuring, tracking, and analyzing productivity and outcome metrics, implementing process improvements and preparing policies and files for audits. The program manager is responsible for working with leaders and staff to standardize processes across all business lines.  

[PRINCIPAL DUTIES:]{.underline}

• Collaborates with UM leadership to evaluate UM programs, identify opportunities for improvement, and implement new processes.
• Creates and implements utilization management workflows.
• Manages maintenance of policies, manuals, etc.
• Participates as a subject matter expert (SME) in internal cross-functional teams to ensure that utilization management programs meet regulatory requirements and elevates risk to leadership when programs are not in compliance.
• Drives program results as a SME for UM systems; Jiva, Provider One, Xcelys, Tableau, Pre-Manage, EPIC and other UM platforms.
• Collaborates with internal teams to revise and enhance utilization management applications.
• Manages regulatory audits including policy and file preparation.
• Prepares and analyzes utilization management productivity and outcome data.
• Measures, tracks, and analyzes department goals.
• Prepares and analyzes specific utilization management program reports and presents to applicable leadership and/or committees.
• Manages program/vendor relationships.
• Develops and implements workflows for system integration and quality assurance.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

[QUALIFICATIONS:]{.underline}

[Education]{.underline} & [Prior Related Experience]{.underline}:

Possess a bachelor's degree or an eq