Director of Utilization Management/Care Management
2 weeks ago
Ochsner Health System is seeking a highly skilled and experienced Director of Utilization Management/Care Management to join our team. As a key member of our leadership team, you will be responsible for developing, implementing, and monitoring strategies for cost reduction and utilization management.
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 offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply for this exciting opportunity.
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New Orleans, LA , USA, United States Ochsner Health System Full timeAbout the RoleOchsner Health System is seeking a highly skilled and experienced Director of Utilization Management/Care Management to lead our Utilization Management Department. As a key member of our leadership team, you will be responsible for developing and implementing strategies to reduce costs and improve patient outcomes.Key ResponsibilitiesLead and...
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New Orleans, LA , USA, United States Ochsner Health System Full timeAbout the RoleWe are seeking a highly skilled and experienced Director of Utilization Management and 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 utilization management and care management processes, ensuring compliance with...
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New Orleans, LA , USA, United States Ochsner Health Full timeJob SummaryOchsner Health is seeking a highly skilled and experienced Director of Utilization Management and Care Coordination to lead our Utilization Review and Revenue Cycle Operations teams. As a key member of our leadership team, you will be responsible for developing and implementing strategies to reduce costs and improve utilization management, while...
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