DIR - UTILIZATION REVIEW / MGMT

UHS•Jacksonville, FL

13h

About The Position

The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to requests for services and interfaces with managed care organization, external reviewers, and other payers. Directly supervises a minimum of 5 staff. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Requirements

Must be a Registered Nurse, and/or have a Bachelor’s Degree in Social Work or Psychology or equivalent education and experience in Utilization Review/ Management.
Has knowledge of regulatory and reimbursement requirements.
Able to monitor and evaluate records for quality and appropriateness of care.
Able to work independently and collegially with all clinical disciplines and staff within the hospital.
Demonstrates leadership ability, good communication skills, ability to delegate and supervise.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports and legal documents.
Ability to respond to common inquiries or complaints from customers, regulatory agencies or members of the business community.
Ability to write speeches and articles for publication that conform to prescribed style and format.
Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Regularly required to stand, walk, and site.
Use hands to finger, handle, or feel.
Reach with hands and arms.
Stoop, kneel, crouch, or crawl.
Regularly lift and/or move up to 25 pounds, and occasionally up to 75 pounds.
Specific vision abilities required: close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

Responsibilities

Directing and overseeing the Utilization Management Department.
Implementation of case management scenarios.
Consulting with all services to ensure the provision of an effective treatment plan for all patients.
Overseeing the response to requests for services.
Interfacing with managed care organizations, external reviewers, and other payers.
Directly supervising a minimum of 5 staff.
Carrying out supervisory responsibilities in accordance with the organization’s policies and applicable laws.
Interviewing, hiring, and training employees.
Planning, assigning, and directing work.
Appraising performance.
Rewarding and disciplining employees.
Addressing complaints and resolving problems.