Director of Utilization Management and Denials
4 weeks ago
Job Summary
WellSpan Health is seeking a highly skilled Director of Utilization Management and Denials to oversee the operations of the utilization management department. The ideal candidate will have a strong background in leadership and experience in utilization management.
Key Responsibilities
- Supervise and oversee the utilization management process for preauthorization, concurrent review, denials, and appeals for System acute care facilities.
- Direct, coordinate, and evaluate the efficiency and productivity of utilization management functions.
- Lead strategic goals and priorities across utilization management that support WellSpan's strategic priorities and objectives.
- Develop, review, implement, and oversee effective administration of Utilization Management workflow and processes in accordance with contract compliance as well as regulatory requirements.
- Oversee and evaluate the activities and effectiveness of Utilization Management activities.
- Build a high-functioning team that meets all operating goals, including quality, efficacy, administrative expense, customer service, performance improvement, regulatory requirement satisfaction, and staff engagement.
- Provide oversight of utilization management, denials, and Prior Authorization activities to ensure utilization review activities are conducted timely in accordance with internal policy and payor requirements.
- Monitor operations and implement strategies that promote compliance with regulatory standards.
- Provide mentoring and coaching to direct reports to build and strengthen Utilization Management effectiveness.
- Ensure regular departmental staff meetings are conducted and action items and follow-up issues are completed.
- Partner with other Departments to develop, implement, and monitor system-wide performance improvement initiatives for Utilization Management measures.
- Coordinate with other operational departments to identify and achieve workflow improvements to gain process and procedure efficiencies and create standardized reporting across all functional areas.
- Identify, design, and implement Process Improvement opportunities that support utilization management operations.
- Participate as a member of Utilization Management Review Committees. Co-chair's System Utilization Management Committee.
- Work closely with Medical Director to identify trends in payor denials and appeals.
- Serve as point of contact for System acute care utilization review issues and resolutions with payers. Collaborate with Payer Contracting regarding payer issues. Attend Joint Operations Committee Meetings with payers.
- Organize and assist Medical Director with System Utilization Management Committee (URC) meetings. Prepare reports for review at the URC meeting.
- Work with medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation for review as well as coding activities and DRG assignments.
Requirements
- Masters Degree Required
- 5 years In leadership experience. Required
- 3 years Utilization Management Experience. Preferred
- Licensed Registered Nurse Preferred
What We Offer
WellSpan Health is an Equal Opportunity Employer. We are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email. We will evaluate requests for accommodation on a case-by-case basis.
-
Clinical Utilization Management Specialist
17 hours ago
York, Pennsylvania, United States WellSpan Health Full timeJob OverviewWe are seeking a highly skilled Clinical Utilization Management Specialist to join our team at WellSpan Health. As a key member of our case management department, you will play a vital role in ensuring that patients receive the most appropriate and effective care possible.About the RoleThis is a full-time position working as part of our clinical...
-
Senior Project Manager
4 weeks ago
York, Pennsylvania, United States IB Abel Inc Full timeJob OverviewIB Abel Inc is seeking an experienced Senior Project Manager to lead utility construction projects in our transmission group. The ideal candidate will have a strong background in project management, excellent communication skills, and the ability to mentor up-and-coming Associate Project Managers.Key Responsibilities:Conduct weekly crew...
-
Managing Director of Distribution
1 month ago
York, Pennsylvania, United States Glatfelter Insurance Group Full timeAbout the PositionGlatfelter Insurance Group is seeking a seasoned professional to lead our distribution efforts. As Managing Director of Distribution, you will be responsible for overseeing the management and leadership of our Public Entities, Ministry Care, and Healthcare Programs.Key ResponsibilitiesDevelop and implement strategic plans to achieve...
-
Program Director
4 weeks ago
York, Pennsylvania, United States Children's Aid Society Full timeJob OverviewChildren's Aid Society is seeking a Program Director to support the implementation of the Youth Court Alliance (YCA) program.The successful candidate will work under the direct supervision of the Director of Clinical Services to manage, coordinate, and oversee the YCA program. Additionally, the Program Director will assist with community...
-
Electric Utility Project Coordinator
4 weeks ago
York, Pennsylvania, United States Welty Building Company Full timeWelty Energy, an affiliate of Welty, is a professional services company specializing in program and project management, transmission line engineering, and substation engineering. Our team provides construction oversight on transmission, substation, and distribution projects ranging in voltages from 4kV to 765kV. Headquartered in Akron, OH, and working...
-
Capital Raising Director
1 month ago
York, Pennsylvania, United States Inch & Co Full timeJob Title: Capital Raising DirectorAt Inch & Co, we are seeking a highly skilled Capital Raising Director to join our team. This role will play a crucial part in shaping our equity capital markets strategy and securing equity capital for our projects.Key Responsibilities:Develop and execute the equity capital strategy to support the firm's commercial real...
-
Director of Imaging Services Operations
1 month ago
York, Pennsylvania, United States WellSpan Health Full timeJob SummaryWe are seeking a highly skilled and experienced Director of Imaging Services Operations to lead our Imaging Department. As a key member of our leadership team, you will be responsible for managing the overall operation and strategic planning of the department.Key ResponsibilitiesDevelop and implement strategic plans to improve imaging services and...
-
York, Pennsylvania, United States WellSpan Health Full timeLead Neurology Division for a Multihospital System in Central PennsylvaniaWe are seeking an experienced Medical Director to lead our Adult Neurology Division across 7 acute care hospitals and 9 clinical sites in central Pennsylvania.Key Responsibilities:Oversight of quality, standardization, and provider engagement in both inpatient and outpatient...
-
Medical Director Opportunity in Pennsylvania
4 weeks ago
York, Pennsylvania, United States Revolution Healthcare Full timeJob SummaryWe are seeking a skilled Anesthesiology Physician to join our team at Revolution Healthcare. As a Medical Director, you will be responsible for leading our anesthesiology department and providing high-quality patient care.Key Responsibilities:Lead and manage the anesthesiology departmentDevelop and implement departmental policies and...
-
Dining Services Director
1 month ago
York, Pennsylvania, United States Chartwells Higher Education Full timeJob OpportunityChartwells Higher Education is seeking a highly motivated and experienced professional to fill the role of Dining Services Director at York College of Pennsylvania. As a key member of our team, you will be responsible for overseeing the day-to-day operations of our residential dining hall, ensuring exceptional food quality, and providing...
-
Clinical Case Manager
4 weeks ago
York, Pennsylvania, United States WellSpan Health Full timeJob SummaryWellSpan Health is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating a patient's progression of care and ensuring the provision of appropriate, cost-effective, and quality healthcare.Key Responsibilities Reviews assigned patients for medical necessity, utilization...
-
Nurse Case Manager
2 weeks ago
York, Pennsylvania, United States WellSpan Health Full timeJob SummaryWe are seeking a skilled Registered Nurse to join our Case Management team at WellSpan Health. As a Nurse Case Manager, you will play a critical role in ensuring that patients receive the most efficient and effective care possible. This position requires a strong background in nursing and case management principles, as well as excellent...
-
York, Pennsylvania, United States Wagman Full timeCompany OverviewWagman, a fourth-generation family-owned construction firm, has been a leader in the industry since 1902. Our company values integrity, mutual respect, safety, innovation, sense of urgency, and community, which have laid the foundation for our success and longevity.We are seeking an experienced Director of Human Resources to join our team. As...
-
Senior Hospice Care Manager
3 weeks ago
York, Pennsylvania, United States Heartland Hospice Full timeJob Title: Senior Hospice Care ManagerWe are seeking a skilled and compassionate Senior Hospice Care Manager to join our team at Heartland Hospice. This is an office position that requires a Registered Nurse with a strong background in hospice care and management.Key Responsibilities:Supervise and manage the day-to-day operations of our hospice sites,...
-
Nurse Professional Staff
1 month ago
York, Pennsylvania, United States UPMC Full timeJob SummaryUPMC is seeking a Professional Staff Nurse to join our team in the Labor and Delivery department. As a Professional Staff Nurse, you will be responsible for providing high-quality patient care and collaborating with the healthcare team to achieve excellent patient outcomes.ResponsibilitiesDevelop and maintain productive working relationships with...
-
Accounting Manager
4 weeks ago
York, Pennsylvania, United States Randstad Full timeWe are seeking a highly skilled Accounting Manager to join our team at Randstad. As a key member of our organization, you will be responsible for overseeing all day-to-day accounting functions, including in-house payroll, accounts payable, and accounts receivable. You will also be responsible for preparing financial reports, taxes, month-end close, cash...
-
Supervisor - Case Management Lead
1 month ago
York, Pennsylvania, United States WellSpan Health Full timeJob SummaryWe are seeking a highly skilled and experienced Clinical Case Management Supervisor to join our team at WellSpan Health. As a key member of our Case Management department, you will be responsible for overseeing the operations of our Case Management team, ensuring the most efficient use of resources to support the provision of appropriate,...
-
Territory Sales Manager
4 weeks ago
York, Pennsylvania, United States 360 Painting of York County Full timeJob DescriptionAt 360 Painting of York County, we are seeking a highly motivated and responsible Territory Sales Manager to join our growing team. Our ideal candidate is self-motivated and looking for an opportunity to develop a great career with a growing company. The successful candidate will be responsible for managing and developing a territory through...
-
Project Director
1 month ago
York, Pennsylvania, United States Cannonball Recruiting LLC Full timeJob OverviewCannonball Recruiting LLC is seeking a seasoned Project Manager to lead municipal public works projects from conception to completion. The ideal candidate will possess a strong track record in managing projects, ensuring timely delivery, budget adherence, and high-quality standards.Key ResponsibilitiesLead civil engineering projects, focusing on...
-
Soccer Shots York Internship Opportunity
4 weeks ago
York, Pennsylvania, United States Soccer Shots of Harrisburg & York Full timeJob DescriptionWe are seeking a highly motivated and enthusiastic individual to join our team as an intern at Soccer Shots of Harrisburg & York. As an intern, you will have the opportunity to gain hands-on experience in coaching, leadership, and customer service while working with a dynamic and caring team.ResponsibilitiesCoaching: You will be responsible...