Market Director of Resource Optimization
2 weeks ago
About Ascension
Ascension Saint Thomas is a leading healthcare system with a 125-year history of providing compassionate care to the community.
We offer a comprehensive network of hospitals, affiliated joint ventures, medical practices, clinics, and specialty facilities, making us one of the largest healthcare systems in Middle Tennessee.
As a faith-based, nonprofit organization, we are committed to delivering high-quality patient care while prioritizing our associates' well-being and growth.
Job Summary
The Director of Utilization Management will lead the day-to-day operations of the utilization management function within the insurance plan, ensuring integration with network strategy and claims processing.
This role requires strategic direction, oversight of staffing, and development of systems and processes for prospective, concurrent, and retrospective utilization review.
The ideal candidate will have experience in utilization management, leadership, and management, with a background in nursing and a strong understanding of healthcare operations.
Responsibilities
- Provide strategic direction and oversight of the utilization management function
- Ensure integration with network strategy and claims processing
- Oversee work with provider relations on resolving issues
- Manage activities related to staffing, including hiring, orienting, evaluating, and disciplinary actions
- Develop systems and processes for prospective, concurrent, and retrospective utilization review
- Oversee implementation and maintenance of prior authorization codes
Requirements
- Licensure: Registered Nurse credentialed from the Tennessee Board of Nursing
- Education: Bachelor's degree in nursing or diploma from an accredited school/college of nursing
- Work Experience: 5 years of experience required, 10 years of experience preferred
- Leadership Experience: 2 years of leadership or management experience required, 5 years of leadership or management experience preferred
Benefits
- Paid time off (PTO)
- Variety of health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
- Ways to give back to your community
Compensation
The estimated salary for this position is $120,000 - $150,000 per year, depending on qualifications and experience.
EEO Statement
Ascension is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive workplace that values diversity, equity, and inclusion.
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