Director of Utilization Management

3 weeks ago


New York, New York, United States WellSpan Health Full time
Job Summary

WellSpan Health is seeking a highly skilled and experienced Director-Utilization and Denials Management to join our team. As a key member of our leadership team, you will be responsible for overseeing the utilization management process, ensuring compliance with regulatory requirements, and developing strategies to improve operational efficiency.

Key Responsibilities
  • 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.
  • 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.
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 offer a competitive salary and benefits package, as well as opportunities for professional growth and development.



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