RN Director Utilization Management ACM
4 weeks ago
- Department: Case Management
- Schedule: Full Time Day Shift
- Hospital: Network Services
- Location: Seton Administrative Offices
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.
ResponsibilitiesProvide 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.
Licensure / Certification / Registration:
- Registered Nurse credentialed from the Texas 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.
Ascension Seton, based in Austin, Texas, has provided thousands of associates and caregivers a rewarding career in healthcare since 1902. Ascension Seton operates more than 100 clinical locations in Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell Children's Medical Center. Join us and create a career path you will love.
Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
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 EmployerAscension 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.
This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.
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