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Senior Director, Utilization Review and Optimization

2 months ago

TX United States Other Executive Full time
Job Summary

We are seeking an experienced Senior Director to lead our Utilization Review and Optimization efforts. This key leadership role will be responsible for developing and implementing strategies to improve the efficiency and effectiveness of our utilization review processes.

Key Responsibilities
  • Lead Utilization Review Teams: Oversee the development and implementation of centralized utilization review teams to promote an appropriate level of care and prevent payer denials.
  • Implement Process Improvements: Develop and implement process improvements to optimize staffing and productivity, and leverage technology to enable program accuracy and effectiveness.
  • Collaborate with Stakeholders: Collaborate with Tenet National Director Clinical Denials, Sr. Director Revenue Cycle, hospital CFOs, Directors Revenue Analysis (DRAs), and Managed Care Contracting to design concurrent processes to secure authorizations and prevent clinical denials.
  • Monitor Performance Metrics: Monitor and manage hospital performance to targets and lead corrective action plans needed to achieve organizational targets.
  • Develop Business Plans: Conduct financial analysis, develop business plans, and secure approval for programs to improve utilization review processes.
Requirements
  • Leadership Experience: A minimum of 4 years hospital or healthcare leadership experience required.
  • Multi-Site Experience: Multi-site leadership experience preferred.
  • Utilization Review Experience: Experience successfully implementing centralized utilization review teams for multi-hospital systems strongly preferred.
  • Technical Skills: Working knowledge of CarePort and MIDAS documentation and reporting required.
  • Education: Advanced degree in Business, Nursing, and/or Healthcare Administration required.