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Market Director of Utilization Management and Operations

1 month ago

Nashville, Tennessee, United States Ascension Full time
Job Summary

We are seeking a highly skilled Market Director of Utilization Management to lead our team in providing strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.

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

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, with more than 250 sites of care that cover a 45-county area in Tennessee consisting of 16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities.

Across the state, Ascension Saint Thomas and its partner organizations employ more than 11,000 dedicated associates who care for millions of patients each year.

Ascension Saint Thomas is part of Ascension, one of the nation's largest faith-based healthcare organizations committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable.

Ascension includes approximately 134,000 associates, 35,000 affiliated providers and 140 hospitals, serving communities in 19 states and the District of Columbia.

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 poster or 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.

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.