Utilization Management Director

2 weeks ago

Centennial, United States CommonSpirit Health Mountain Region Full time

Welcome to CommonSpirit Health Mountain Region:

CommonSpirit Health Mountain Region is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen - both inside our hospitals and out in the community. With locations throughout Colorado, Utah, and Kansas, we deliver the same high standard of care to our employees as we do to our patients. Our 20 hospitals, emergency and urgent care centers, home care and hospice, Flight for Life Colorado TM, telehealth and over 240 physician practices and clinics offer endless opportunities Here, you can grow your career and impact the people in the communities you serve.

CommonSpirit Health is one of the nation's largest nonprofit, faith-based health systems, with a team of over 150,000 employees and 25,000 physicians and advanced practice clinicians. CommonSpirit operates more than 2,200 care sites and 140 hospitals, serving some of the most diverse communities across the nation, letting humankindness lead the way.

Overview:

You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills - but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success.

The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops strategies to achieve departmental and CommonSpirit Health goals and objectives.

This position directs the UM staff to meet or exceed operational performance standards. The Director oversees development and implementation of UM policies, procedures and processes; directs and assists with accreditation activities; efficient management of payer requirements, addressing denials effectively, and compliance with payer and regulatory requirements, and reviews and analyzes UM program outcomes and quality metrics.

Qualifications:

In addition to bringing humankindness to the workplace each day, qualified candidates will need the following:

  • Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
  • Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination).
  • 5 years of progressively responsible management experience.
  • Extensive operational experience in managed care; extensive experience in program planning, implementation, staff development, and needs assessment.
  • Comprehensive knowledge of utilization management, financial management that includes revenue cycle, Medicare, Medicaid, and commercial admission and review requirements.
Your Connected Community:

We believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness.

Our Total Reward Offerings:

We believe investing in our employees lets them know they truly matter. Your Total Rewards package includes compensation, benefits, retirement, wellness, leave, and other programs. Designed with your well-being in mind, we offer:

  • Several Medical, Dental, & Vision options.
  • Spending Accounts including a Dependent Care FSA that can include an employer contribution.
  • Retirement account options with a generous employer match.
  • Tuition Reimbursement.
  • Student Loan Forgiveness, and so much more

View more on our benefits HERE.

Pay Range:

$50.44 - $85.10 / hour

Shift:

Days

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