Director of Utilization Management

1 month ago

Anchorage, Alaska, United States Alaska Native Tribal Health Consortium Full time
Job Title: Director of Utilization Management

At the Alaska Native Tribal Health Consortium, we are seeking a highly skilled and experienced Director of Utilization Management to join our team. As a key member of our healthcare operations team, you will be responsible for developing and implementing strategic processes to improve productivity and efficiencies of insurance verification, prior authorization, and utilization review at the Alaska Native Medical Center.

Responsibilities:
  • Support continuous clinical improvement activities at ANMC by analyzing department processes for efficiency and effectiveness to ensure facilitation of optimum reimbursement while complying with government and private insurance reimbursement policies.
  • Develop department goals and processes to monitor accuracy, timeliness, and outcomes of insurance verifications, prior-authorizations, and clinical reviews.
  • Monitor concurrent reviews to assure that care meets national standards, is timely, and cost effective.
  • Assure compliance with all regulatory and accreditation requirements.
  • Coordinate with other ANMC department Directors to prepare the annual Utilization Review Plan in compliance with CoP.
  • Presents analysis and reports of significant utilization trends, patterns and impact to resources to the Utilization Review Committee, Administration and Senior Management as appropriate or requested.
  • Through effective coordination of information, assures effective communication between ANMC departments.
  • Consults with other Directors and providers to develop improved utilization of services and resources.
  • Serves as a liaison between ANMC departments, various Regional organizations and state and Federal agencies; serves on committees, task forces and other groups as appropriate.
  • Manages, develops and coaches staff, building on individual strengths and assists in setting professional goals.
  • Develops orientation and ongoing department training to expand staff knowledge, confidence, proficiency in duties and efficiency in productivity.
  • Implements corrective actions and conducts performance evaluations.
  • Compiles and maintains records, reports and statistical information for evaluation and planning.
  • Provides leadership, direction and guidance on professional responsibilities and technical skills.
  • Meets regularly with staff to resolve workload and technical issues.
  • Assures staff remains certified and licensed in their fields of expertise as required by regulation or ANMC policy.
  • Recommends staffing allocations and equipment requirements.
  • Coordinates ancillary staff support for the Unit.
  • Maintains appropriate Unit performance records and prepares summary reports as required.
Requirements:
  • Bachelors degree in related healthcare field required.
  • Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.
  • Non-supervisory – Ten (10) years of responsible utilization management experience AND Supervisory – Five (5) years involving professional employee supervision.
Preferred Qualifications:
  • May be required to work outside the traditional work schedule.
  • May be called out to work off-shift in emergency situations.

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