Market Director of Clinical Optimization

3 weeks ago


Nashville, Tennessee, United States Ascension Full time
Job Summary

We are seeking a highly skilled Market Director of Clinical Optimization to join our team at Ascension Saint Thomas. This role will be responsible for providing strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.

Key Responsibilities
  • Ensure integration of utilization management functions with network strategy and claims processing.
  • Oversee work with provider relations on resolving issues.
  • Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
  • Develop systems and processes for prospective, concurrent, and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.
  • Oversee implementation and maintenance of prior authorization codes for all clients.
Requirements
  • Licensure / Certification / Registration: Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.
  • Education: Bachelor's degree in nursing or diploma from an accredited school/college of nursing required. Master's degree or combination of Bachelor's degree and experience preferred.
  • Work Experience: 5 years of experience required. 10 years of experience preferred. 2 years of leadership or management experience required. 5 years of leadership or management experience preferred.
About Ascension Saint Thomas

Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community. We offer a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee. Our team of dedicated associates care for millions of patients each year, and we are committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable.

Equal Employment Opportunity Employer

Ascension Saint Thomas is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive environment where all associates feel valued, respected, and supported.



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