Director-Utilization and Denials Management

The Director of Utilization and Denials Management at WellSpan Health is responsible for supervising and overseeing the operations of the utilization management department. This role involves collaboration with various departments including hospital, regional, medical group, Population Health, post-acute services, revenue services, and system leadership to support the operational achievement of strategic goals. The Director will play a key role in the innovation, design, and implementation of new strategies aimed at improving operations and clinical services. A significant aspect of this position is to enhance WellSpan Health's utilization management capabilities through the development of strong management relationships with interdisciplinary teams such as the Insurance Specialty Center, Payor Contracting, Compliance, IT, Finance, and Regulatory Affairs. The Director will oversee the utilization management process, which includes preauthorization, concurrent review, denials, and appeals for System acute care facilities. This position requires directing, coordinating, and evaluating the efficiency and productivity of utilization management functions. The Director will lead strategic goals and priorities that align with WellSpan's objectives, ensuring effective administration of Utilization Management workflows and processes in compliance with contracts and regulatory requirements. Additionally, the Director will build a high-functioning team that meets operational goals, including quality, efficacy, customer service, and staff engagement. In this role, the Director will monitor operations to promote compliance with regulatory standards, provide mentoring and coaching to direct reports, and ensure regular departmental meetings are conducted. The Director will also partner with other departments to develop and monitor system-wide performance improvement initiatives for Utilization Management measures, coordinate with operational departments to identify workflow improvements, and implement process improvement opportunities. Participation in Utilization Management Review Committees and collaboration with the Medical Director to identify trends in payor denials and appeals are also key responsibilities. The Director will serve as the point of contact for System acute care utilization review issues and resolutions with payers, and will assist in organizing and preparing reports for System Utilization Management Committee meetings.