Clinical Manager, Utilization Management, Full-Time, Days (For internal candidate only)
About The Position
The UM Manager is responsible for assisting with the overall operations and direction of the Utilization Management department. The UM Manager is responsible for incorporating best practices and ensures effective utilization reviews that will guarantee appropriate reimbursement for hospital services and manages and ensures the productivity of the department in completing initial reviews and concurrent reviews to ensure that the patient is getting the right care in a timely, safe, efficient, and cost-effective way. Additionally, the UM manager must monitor retrospective reviews after treatment has been completed or after discharge to ensure appropriate reimbursement. Works collaboratively with Care Management leadership in providing feedback about any opportunities, trends, and gaps regarding avoidable days or delays or develops a plan when a patient is no longer meeting the acute level of care. Additionally, the UM Manager works closely with physicians and other providers including the Physician Advisor to develop improved utilization of effective and appropriate services. The UM Manager will provide after-hour support for the Access Department and serve as a point of contact for conflict resolution and provide administrative support for both UM Department and Access Department.
Requirements
- Full-Time
- Days
Responsibilities
- Assisting with the overall operations and direction of the Utilization Management department.
- Incorporating best practices and ensuring effective utilization reviews to guarantee appropriate reimbursement for hospital services.
- Managing and ensuring the productivity of the department in completing initial reviews and concurrent reviews.
- Monitoring retrospective reviews after treatment has been completed or after discharge to ensure appropriate reimbursement.
- Collaborating with Care Management leadership in providing feedback about opportunities, trends, and gaps regarding avoidable days or delays.
- Developing a plan when a patient is no longer meeting the acute level of care.
- Working closely with physicians and other providers, including the Physician Advisor, to develop improved utilization of effective and appropriate services.
- Providing after-hour support for the Access Department.
- Serving as a point of contact for conflict resolution.
- Providing administrative support for both UM Department and Access Department.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
