Director of Utilization Management and Care Coordination
2 weeks ago
Ochsner Health is seeking a highly skilled and experienced Director of Utilization Management and Care Coordination to lead our Utilization Review and Revenue Cycle Operations teams. As a key member of our leadership team, you will be responsible for developing and implementing strategies to reduce costs and improve utilization management, while ensuring compliance with regulations and industry standards.
Key Responsibilities- Lead and direct Utilization Review staff and functions, including staffing, staff engagement, training, purchasing, departmental budgeting, and labor management.
- Develop and implement 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.
- Bachelor's degree in nursing required; Master's degree in nursing preferred.
- 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 required; Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Professional in Healthcare Management (CPHM) certifications preferred.
- Strong leadership and management skills, with experience in leading cross-functional teams.
- Excellent communication and interpersonal skills, with the ability to present information clearly and professionally.
- Ability to analyze complex data and make informed decisions.
- Experience with regulatory compliance and industry standards.
Ochsner Health 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 healthcare outcomes, we encourage you to apply for this exciting opportunity.
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New Orleans, Louisiana, United States Ochsner Health Full timeJob SummaryWe are seeking a highly skilled and experienced Director of Utilization Management and Care Coordination to join our team at Ochsner Health. This is a critical leadership role that requires a strong understanding of healthcare operations, strategic planning, and team management.The successful candidate will be responsible for developing and...
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New Orleans, Louisiana, United States Ochsner Health Full timeJob SummaryWe are seeking a highly skilled and experienced Director to lead our Utilization Management and Care Coordination team at Ochsner Health. As a key member of our leadership team, you will be responsible for developing and implementing strategies to optimize patient care and outcomes while ensuring compliance with regulatory requirements.Key...
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New Orleans, LA , USA, United States Ochsner Health System Full timeAbout the RoleOchsner Health System is seeking a highly skilled and experienced Director of Utilization Management/Care Management to lead our Utilization Management Department. As a key member of our leadership team, you will be responsible for developing and implementing strategies to reduce costs and improve patient outcomes.Key ResponsibilitiesLead and...
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New Orleans, LA , USA, United States Ochsner Health System Full timeAbout the RoleWe are seeking a highly skilled and experienced Director of Utilization Management and Care 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 optimize utilization management and care management processes, ensuring compliance with...
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New Orleans, Louisiana, United States Ochsner Health System Full timeJob SummaryOchsner Health System is seeking a highly skilled and experienced Director of Utilization Management and Care Management to join our team. As a key member of our leadership team, you will be responsible for developing and implementing strategies to optimize resource utilization and improve patient outcomes.Key ResponsibilitiesDevelop and implement...
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