Market Director of Utilization Management

7 days ago


Lexington, Kentucky, United States Chi Full time
Job Summary

We are seeking a highly skilled and experienced Market Director of Utilization Management to join our team at CHI Saint Joseph Health. This is a key leadership role that requires a strong understanding of healthcare operations, utilization management, and care coordination.

Key Responsibilities
  • Develop and implement utilization management programs to ensure efficient and effective care delivery.
  • Collaborate with care coordination teams to ensure seamless transitions of care and optimal patient outcomes.
  • Lead the development and implementation of policies, procedures, and processes to ensure compliance with regulatory requirements and industry standards.
  • Provide strategic direction and oversight to ensure the achievement of departmental and organizational goals.
  • Develop and manage budgets, forecasts, and performance metrics to ensure optimal resource allocation and utilization.
Requirements
  • Bachelor's degree in Nursing, Healthcare Administration, or related field.
  • Minimum 3 years of clinical case management experience, with a focus on utilization management and care coordination.
  • 5 years of progressively responsible management experience, with a strong track record of leadership and team management.
  • Comprehensive knowledge of healthcare operations, utilization management, and care coordination.
  • Strong analytical, problem-solving, and communication skills.
Preferred Qualifications
  • Master's degree in Nursing, Healthcare Administration, or related field.
  • Experience with data analytics, cost containment, and clinical outcomes.
  • Knowledge of DRG, reimbursement, pricing, and coding processes for inpatient and outpatient services.

CHI Saint Joseph Health is a leading healthcare provider in Central and Eastern Kentucky, with a commitment to delivering high-quality, patient-centered care. We are proud to be part of CommonSpirit Health, a national healthcare organization dedicated to advancing health and well-being.



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