Director - OHP Utilization Management/Care Management
3 weeks ago
We are seeking a highly skilled and experienced Director of Utilization Management/Care Management to join our team at Ochsner Health System. As a key member of our leadership team, you will be responsible for developing and implementing strategies to optimize patient care and reduce healthcare costs.
Key Responsibilities- Lead and direct Utilization Review (UR) staff and functions, including staffing, staff engagement, training, purchasing, departmental budgeting, and labor management.
- Assist in developing policies, standard operating procedures, and programs that incorporate best practices and ensure effective, compliant utilization reviews.
- Implement and lead regulations for utilization management, including admission and continued stay medical necessity criteria review, payer authorization, denials management, and ensures adherence to the established utilization management plan.
- Manage and monitor performance to ensure reviews are completed accurately and are appropriately reviewed with Providers in a timely manner.
- Manage the completion of retro-active audit reviews to identify escalation issues regarding Providers, other facility issues, individual utilization review staff skills, payor-based concerns, and to provide teaching material for UR staff.
- Analyze and report utilization trends, patterns, and impacts to the organization and make suggestions for improvement.
- Appropriately escalate payor-based issues on both individual cases and identifies practice pattern issues to ensure appropriate coverage of patient's stay.
- Adapt behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions, and communication style.
- Required - Bachelor's degree in nursing.
- Preferred - Master's degree in nursing.
- Required - 7 years of case management experience in a managed care or acute care setting, including 3 years of leadership experience.
- Required - Registered Nurse (RN) license in the state of practice.
- Preferred - Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Professional in Healthcare Management (CPHM).
Ochsner Health System is committed to providing a work environment that is free from discrimination and harassment. We are an equal opportunity employer and welcome applications from diverse candidates. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
How to ApplyIf you are a motivated and experienced professional looking for a new challenge, please submit your application, including your resume and cover letter, to our careers website. We look forward to hearing from you
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