Director of Utilization Management

Trinity Health • Columbus, OH

6d • Onsite

About The Position

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

Position Purpose:
Director Utilization Review directs the department's activities and resources to ensure alignment with the mission, values, and objectives of the department and organization

Requirements

• Bachelor of Science Degree in Nursing, Business or other Healthcare related field.
• RN License through the State of Ohio
• 10+ years experience in clinical nursing and utilization management with at least 3+ years of utilization management experience at a Managed Care organization.
• Working knowledge of utilization review practices related to regulatory and accreditation requirements.
• Proven team leader with the ability to interact with all levels of staff members and physicians and other healthcare providers.
• Ability to prioritize issues and solve complex problems.
• Proficient computer, written and verbal communication skills including presentation skills.
• Innovative and self-directed.
• Demonstrates a high tolerance for ambiguity and change and provides leadership to department colleagues and others to adapt effectively to meet changing environment.

Nice To Haves

• Master's Degree preferred

Responsibilities

• Develops and implements departmental strategic goals, plans, and standards consistent with the clinical, administrative, legal, and ethical requirements/objectives of the organization.
• Oversees compliance with regulations, laws and ethics via audits and direct observation.
• Provides leadership in developing and implementing standardized tools, roles and systems to support Utilization Review
• Directs and evaluates departmental operations.
• Leads operational improvements to facilitate standardization of utilization review practices.
• Establishes metrics to achieve service targets.
• Oversees and evaluates programs and services focused on continuous quality improvement.
• Participates in review of contracts and agreement of services
• Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary and continuing education initiatives.
• Develops network of high performing teams
• Prepares, monitors, and evaluates departmental budgets, and ensures that the department operates within the allocated funding
• Participates as an active management member of the Mount Carmel Health Plan representing the Utilization Review Department in collaboratively meeting operational, budget, and strategic planning goals

Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

What This Job Offers

• Job Type: Full-time
• Career Level: Director