Market Director of Utilization Management

1 week ago

Nashville Tennessee, Davidson County, TN, United States Ascension Full time
Details
  • Department: Utilization Management
  • Schedule: Monday - Friday. 40 hours week.
  • Hospital: Ascension Saint Thomas
  • Location: Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN market.

We’re looking for an experienced Director of Utilization Management to join our team In this pivotal role, you’ll lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. You’ll collaborate with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and innovate? Apply now

Benefits

Paid time off (PTO)
Various 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

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.

  • 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.
Additional Preferences
  • Utilization Management experience preferred.
Why Join Our Team

Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities.

Ascension is a leading non-profit, faith-based national health system made up of thousands of associates delivering compassionate, personalized care across hospitals, clinics and senior living communities.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

E-Verify

  • Marketing Events Manager

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States HealthTrust Part time

    Description IntroductionDo you have the career opportunities as a Marketing Events Manager you want with your current employer? We have an exciting opportunity for you to join HealthTrust which is part of the nation's leading provider of healthcare services, HCA Healthcare.BenefitsHealthTrust, offers a total rewards package that supports the health,...

  • Senior Manager Digital Marketing

    7 days ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States HealthTrust Part time

    Description IntroductionDo you want to join an organization that invests in you as a(an) Senior Manager Digital Marketing? At HealthTrust, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.BenefitsHealthTrust, offers a total rewards package that supports the...

  • Senior Director Contracts

    1 week ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States HealthTrust Part time

    Description This position is incentive eligible. IntroductionAre you looking for a work environment where diversity and inclusion thrive? Submit your application for our Senior Director Contracts opening with HealthTrust today and find out what it truly means to be a part of the HCA Healthcare team.The Senior Director Contracts is responsible for...

  • Senior Director Contracts

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States HealthTrust Part time

    Description This position is incentive eligible. IntroductionAre you looking for a work environment where diversity and inclusion thrive? Submit your application for our Senior Director Contracts opening with HealthTrust today and find out what it truly means to be a part of the HCA Healthcare team.BenefitsHealthTrust, offers a total rewards package that...

  • RN-Educator

    1 week ago

    Nashville, Tennessee, 37205, Davidson County, TN, United States Ascension Full time

    Details Department: EducationSchedule: Full-timeHospital: Ascension Saint Thomas West Location: Nashville, TNBenefits Paid time off (PTO) Various 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...

  • RN-Educator

    4 weeks ago

    Nashville, Tennessee, 37205, Davidson County, TN, United States Ascension Full time

    Details Department: EducationSchedule: Full-timeHospital: Ascension Saint Thomas West Location: Nashville, TNBenefits Paid time off (PTO) Various 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...

  • HVAC Account Manager

    4 days ago

    Nashville, Tennessee, 37247, Davidson County, TN, United States Johnson Controls Full time

    Build your best future with the Johnson Controls Team  As a global leader in smart, healthy and sustainable buildings, our mission is to reimagine the performance of buildings to serve people, places and the planet.  Join a winning team that enables you to build your best future! Our teams are uniquely positioned to support a multitude of industries...

  • F&B Manager

    2 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Yearly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Safety Director

    1 month ago

    NASHVILLE, Tennessee, 37244, Davidson County, TN, United States US0060 Sysco Nashville, LLC Full time

    JOB SUMMARYThis Operating Company (OpCo) based position will lead the implementation of prevention-focused health, safety and environmental (HSE) and security program. The position will establish, execute and deliver OpCo-specific strategy that supports Sysco's overall HSE objectives, including security and crisis preparedness...

  • Senior Manager Surgery Services and Sustainability

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States HealthTrust Part time

    Description IntroductionDo you want to join an organization that invests in you as a Senior Manager Surgery Services and Sustainability? At HealthTrust, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.BenefitsHealthTrust, offers a total rewards package that...

  • Turndown Attendant

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Receiving Agent

    2 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Case Management Registered Nurse

    2 weeks ago

    Nashville, Tennessee, 37207, Davidson County, TN, United States TriStar Skyline Medical Center Part time

    DescriptionIntroductionDo you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At TriStar Skyline Medical Center our nurses set us apart from any other healthcare provider. We are seeking a(an) Case Management Registered Nurse to join our healthcare family.Benefits TriStar Skyline Medical Center,...

  • Case Management Registered Nurse

    2 days ago

    Nashville, Tennessee, 37207, Davidson County, TN, United States TriStar Skyline Medical Center Part time

    Description IntroductionDo you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At TriStar Skyline Medical Center our nurses set us apart from any other healthcare provider. We are seeking a(an) Case Management Registered Nurse to join our healthcare family.BenefitsTriStar Skyline Medical Center,...

  • In-Room Dining Server

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Yolan Barista

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Spa Attendant

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Front Desk Agent

    2 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Public Area Attendant

    4 weeks ago

    Nashville, Tennessee, 37203, Davidson County, TN, United States The Joseph, a Luxury Collection Hotel, Nashville Full time

    Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America, and the...

  • Inpatient Rehab Nurse Manager

    2 weeks ago

    Hermitage, Tennessee, 37076, Davidson County, TN, United States TriStar Summit Medical Center Part time

    Description IntroductionLast year alone, HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As an Inpatient Rehab Nurse Manager with TriStar Summit Medical Center, you can be a manager in an organization that is devoted to giving!BenefitsTriStar Summit Medical Center offers a total rewards package that supports the health,...