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Director - OHP Utilization Management/Care Management

1 month ago

New Orleans, Louisiana, United States Ochsner Health System Full time
Job Summary

We are seeking a highly skilled and experienced Director of Utilization Management to join our team at Ochsner Health System. As a key member of our leadership team, you will be responsible for developing and implementing strategies to reduce costs and improve utilization management across our organization.

Key Responsibilities
  • Develop and implement utilization management strategies to reduce costs and improve patient outcomes
  • Lead and direct a team of utilization review staff, including staffing, staff engagement, training, purchasing, and labor management
  • Assist in developing policies, standard operating procedures, and programs that incorporate best practices and ensure effective, compliant utilization reviews
  • Implement and lead regulations for utilization management, including admission and continued stay medical necessity criteria review, payer authorization, denials management, and ensures adherence to the established utilization management plan
  • Manage and monitor performance to ensure reviews are completed accurately and are appropriately reviewed with providers in a timely manner
  • Analyze and report utilization trends, patterns, and impacts to the organization and make suggestions for improvement
  • Adapt behavior to the specific patient population, including respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions, and communication style
Requirements
  • Bachelor's degree in nursing
  • 7 years of case management experience in a managed care or acute care setting, including 3 years of leadership experience
  • Registered Nurse (RN) license in the state of practice
  • Preferred: Master's degree in nursing, Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Professional in Healthcare Management (CPHM)
What We Offer

Ochsner Health System offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced leader who is passionate about improving patient outcomes and reducing costs, we encourage you to apply for this exciting opportunity.