Director, UM
1 month ago
What You’ll Be Doing:
As a Director, Utilization Management, you’ll work with your managers, front line clinical team, and matrix partners to ensure delivery on clinical excellence, performance guarantees, and efficiencies for our members, providers, and customers.
The Director, Utilization Management, will partner with a variety of different departments, including but not limited to, Medical Leaders, Partner Operations, Quality/Compliance, Implementations.
What You Will Be Doing:
Leadership of utilization management (UM) activities including design, implementation, and oversight of the operations. Operational activities include clinical review of prior authorization requests and support additional features such as training, appeals, and grievances for clients who have delegated UM.
Monitor all activities related to clinical review. Develop processes where indicated with direct oversight of centralized telephonic review process of all necessary utilization management components.
Partner with leadership to mentor staff. Jointly develop goals, objectives and define major roles. Implement processes, procedures and accountabilities for staff.
Responsible for achieving targeted utilization management results established by the department and/or client by monitoring and reporting the utilization management resources, implementing initiatives and educational processes.
Develop and adopt best practice methodologies and training programs for utilization management tools and techniques.
Provide recommendations on staffing plans, and assuring adequate allocation of resources for UM functions, and coordinating needs with market clinical leadership.
Collaborate with IT and Analytics teams for the development of required utilization management monitoring, initiatives, patient engagement and other outcomes initiatives.
Collaborate with other functional areas that interface with the utilization management department, including but not limited to claims, appeals, product, network development and care management.
Provide appropriate and timely management of complex clinical issues.
Mentor and support ongoing training and development of staff.
Promote a positive work environment by providing timely, specific and constructive performance feedback.
All other duties as assigned.
Qualifications - Required and Preferred:
Active clinical license such as Registered Nurse (RN), Physical/Occupational/Speech/Radiation Therapist or Chiro, Pharmacist -
Required
Working knowledge of utilization management activities such as prior authorization, concurrent review, intake, appeals and grievances -
Required
Five (5) to seven (7) years of progressive experience in utilization management -
Required
Bachelor’s Degree in Nursing or related healthcare field (with Bachelor’s/Master’s Degree in Business Administration/Hospital Administration/ Public Health) -
Preferred
#J-18808-Ljbffr
We have other current jobs related to this field that you can find below
-
Director Sponsored Programs Administration
1 week ago
Bay St Louis, United States University of Mississippi Full timeNote for Current UM Employees Current employees must apply internally via connectU > connectu.olemiss.edu Definition of Class This position provides leadership and support for the Sponsored Programs Administration (SPA) activities of the Office of Research and Sponsored Programs. The incumbent is responsible for guiding pre and post-award activities, with...
-
Strategic Communications Director
1 month ago
Bay St Louis, United States University of Mississippi Full timeDefinition of Class This position manages the development of institutional strategic communications with emphasis on campus communications and support for the Office of the Chancellor. The incumbent develops key messages for a wide range of issues facing the university, develops executive responses for sensitive and complex matters, and creates and directs...
-
Admissions Counselor
4 weeks ago
Bay St Louis, United States University of Mississippi Full timeNote for Current UM Employees Current employees must apply internally via connectU > connectu.olemiss.edu Definition of Class This position performs duties to identify and recruit prospective students. The incumbent plans and participates in the implementation and recruitment of prospective students using marketing strategies and public relations skills, and...
-
Family Medicine job in Port St. Lucie FL
2 months ago
Port St Lucie, United States HCA Full timeDescription Specialization: Family Medicine with OB Job Summary: Core Faculty Recruitment: HCA Healthcare East Florida is seeking a dynamic physician leader interested in medical education to serve as core faculty in our family medicine residency program at HCA Florida St. Lucie Hospital. We are looking for a family medicine/surgical OB. Our East Florida...
-
Family Medicine GME Core Faculty Physician
3 weeks ago
Port St Lucie, United States HCA Florida St. Lucie Hospital Full timeDescription Specialization: Family Medicine without OB Family Medicine with OB Job Summary: Core Faculty Recruitment: HCA Healthcare East Florida is seeking a dynamic physician leader interested in medical education to be part of our family medicine residency program at HCA Florida St. Lucie Hospital as core faculty. Hospitalist and out-patient positions...
-
Family Medicine with OB GME Core Faculty
1 month ago
Port St Lucie, United States HCA Florida St. Lucie Hospital Full timeDescription Specialization: Family Medicine with OB Job Summary: Core Faculty Recruitment: HCA Healthcare East Florida is seeking a dynamic physician leader interested in medical education to serve as core faculty in our family medicine residency program at HCA Florida St. Lucie Hospital. We are looking for a family medicine/surgical OB. Our East Florida...
-
Family Medicine GME Core Faculty Physician
3 weeks ago
Port St Lucie, United States HCA Florida St. Lucie Hospital Full timeDescription Specialization:Family Medicine without OBFamily Medicine with OBJob Summary:Core Faculty Recruitment:HCA Healthcare East Florida is seeking a dynamic physician leader interested in medical education to be part of our family medicine residency program at HCA Florida St. Lucie Hospital as core faculty. Hospitalist and out-patient positions...
