Market Director of Utilization Management

1 week ago


Belle Meade, United States Ascension Full time
Details
  • Department: Utilization Management
  • Schedule: Monday - Friday. 40 hours week.
  • Hospital: Ascension Saint Thomas
  • Location: Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN market.

We’re looking for an experienced Director of Utilization Management to join our team In this pivotal role, you’ll lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. You’ll collaborate with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and innovate? Apply now

Benefits

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.

  • Ensure integration of utilization management functions with network strategy and claims processing.
  • Oversee work with provider relations on resolving issues.
  • Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions,
    and continuing education initiatives.
  • Develop systems and processes for prospective, concurrent and retrospective utilization review for all
    self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient
    utilization management programs.
  • Oversee implementation and maintenance of prior authorization codes for all clients.
Requirements

Licensure / Certification / Registration:

  • Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.


Education:

  • Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.
    • Master's degree or combination of Bachelor's degree and experience preferred.


Work Experience:

  • 5 years of experience required.
  • 10 years of experience preferred.
  • 2 years of leadership or management experience required.
  • 5 years of leadership or management experience preferred.
Additional Preferences
  • Utilization Management experience preferred.
Why Join Our Team

Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities.

Ascension is a leading non-profit, faith-based national health system made up of thousands of associates delivering compassionate, personalized care across hospitals, clinics and senior living communities.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

E-Verify



  • Belle Meade, United States Ascension Full time

    Ascension Saint Thomas is a leading healthcare system in Middle Tennessee with a 125-year history of providing care to the community. We are seeking an experienced Director of Utilization Management to lead our utilization management function and contribute to the development of comprehensive outpatient and inpatient utilization management programs.


  • Belle Meade, United States Stoltz Management of Delaware Full time

    Real estate private equity firm with extensive holdings throughout the U.S. is seeking a highly motivated and talented Property Manager to join its team. The firm's portfolio for which the candidate will be responsible includes office, retail, and industrial properties in the Southeast region of U.S. This position involves travel to properties in multiple...

  • Rehab Director

    13 hours ago


    Belle Plaine, IA, United States Blue Stone Therapy Full time

    Blue Stone Therapy is certified as a Great Place to Work! Blue Stone Therapy was founded in 2009 and provides contract physical therapy, occupational therapy, and speech-language pathology to communities in Iowa, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota.  Our focus is to deliver optimal, individualized rehabilitation by...

  • Account Manager

    3 weeks ago


    Belle Meade, United States Hilti North America Full time

    Job reference: WD-0031615 Account Manager Nashville What's the role? Our account managers serve as the go-to contact for our customers, embodying our purpose to make construction better by being their partner for productivity, safety, and sustainability. You will manage your own portfolio of customer accounts and be given ownership to build a work schedule...

  • Recreation Director

    2 days ago


    Belle Terre, United States The W Management Group LLC Full time

    OverviewRecreation DirectorExcellent Benefits • Supportive Management • Immediately Available The W Group is looking to hire a Recreation Supervisor, with a "Yes I can" attitude. We have our eye out for a compassionate, imaginative, and energetic candidate. Full -Time • Days • Schedule: Sunday through Thursday, or Tuesday through Saturday 11am to...


  • Belle Glade, Florida, United States HTG Management LLC Full time

    We are seeking a highly motivated and detail-oriented Leasing Property Specialist to join our team at HTG Management LLC. This is an exciting opportunity to work in a fast-paced environment, utilizing your skills to provide exceptional customer service and drive business results.About the RoleThe Leasing Property Specialist will be responsible for...


  • Belle Isle, United States Jobot Full time

    Job DescriptionJob DescriptionDirector of Operations, Conway/Belle Isle Orlando Area, Commercial Services, reply to https://jobot.com/apply/director-of-operations/416719262?utm_source=ZipRecruiterThis Jobot Job is hosted by: David HyonAre you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending us your resume.Salary: $80,000 - $120,000 per...


  • Belle Glade, Florida, United States HTG Management LLC Full time

    Job OverviewThe Leasing Operations Coordinator is responsible for promoting the positive image of our apartment community, implementing leasing and marketing programs to drive business growth.About HTG Management LLCWe are a leading property management company dedicated to providing exceptional resident experiences.ResponsibilitiesImplement leasing...


  • Fort Meade, Maryland, United States Y-Tech, LLC Full time

    Job OverviewWe are seeking an experienced Strategic Operations Director to join our team at Y-Tech, LLC. This role is ideal for a highly motivated individual with a strong background in program management.Salary: $120,000 - $180,000 per yearJob ResponsibilitiesThe Strategic Operations Director will be responsible for working closely with the program sponsor...

  • Registered Nurse

    2 months ago


    Belle Mead, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Belle Mead, NJ area for the following position: Registered Nurse - Behavioral Health Director. Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, Behavioral health, CNO, Charge, Clinical Nurse Coordinator,...


  • Fort Meade, Florida, United States Corvias Full time

    About the RoleWe are seeking a seasoned maintenance professional to join our team as a Multifamily Maintenance Operations Director. As a key member of our management team, you will be responsible for overseeing the day-to-day operations of our multifamily properties.


  • Belle Chasse, Louisiana, United States US Foods, Inc. Full time

    As a key member of the US Foods, Inc. team, the Operations and Maintenance Director will oversee the daily work and safety of associates engaged in fleet, building, grounds, sanitation, refrigeration systems, power industrial equipment, and security maintenance.Key Responsibilities:Manage daily operations, ensuring timely completion of facility projects and...

  • RN-Educator

    4 weeks ago


    Belle Meade, United States Ascension Full time

    Details Department: EducationSchedule: Full-timeHospital: Ascension Saint Thomas West Location: Nashville, TNBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...

  • RN-Educator

    7 days ago


    Belle Meade, United States Ascension Full time

    Details Department: EducationSchedule: Full-timeHospital: Ascension Saint Thomas West Location: Nashville, TNBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...


  • Belle Mead, United States Incredible Health Full time

    At Incredible Health, we are actively hiring for a Behavioral Health Manager position in the Belle Mead, NJ area.About the Role:This is an exciting opportunity for nurses with experience in behavioral health to join our team. We are looking for professionals who have worked in various areas such as assistant nurse manager, behavioral health, CNO, charge,...


  • Fort Meade, United States Amentum Full time

    Amentum is seeking a Senior Administrative and Management Support. The AA independently accomplishes general or routine office administrative tasks. The AA should have the expertise and qualifications to accomplish moderately complex administrative tasks with minimal guidance and assistance. Depending on the customer office, some tasks can be more dynamic...

  • Director of Nursing

    13 hours ago


    Belle Glade, FL, United States Wellpath Full time

    Wellpath Director of Nursing Belle Glade, Florida Apply Now • Make a difference every day in the lives of the underserved • Join a mission-driven organization with a people-first culture • Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients • Diversity,...


  • Belle Chasse, United States Plaquemines Port Full time

    Plaquemines Port has an immediate opening for a full-time unclassified Chief Administrative Officer (CAO) to perform the day-to-day administrative operations of the Port, contributing to setting and achieving strategic plans and goals for the various Port departments, collaborating on policy implementation, legislation and ensures the smooth running of the...


  • Belle Glade, United States HTG Management LLC Full time

    SUMMARY The Resident Activities Coordinator works directly for the Property Manager. The Resident Activities Coordinator will coordinate and facilitate various activities and training methods to assist adult residents with improving their prospects for self-sufficiency, health care and economic self-reliance. In addition, the Coordinator will assist...


  • Belle Glade, Florida, United States The McKernan Group Full time

    Company OverviewThe McKernan Group is a dynamic and progressive organization that values teamwork, resilience, and goal-oriented individuals. With a strong presence in West Palm Beach, FL, we offer a unique opportunity for talented professionals to excel in the insurance and financial services industry.Estimated Salary: $80,000 - $150,000 per yearA...