Director-Utilization Management
About The Position
ESSENTIAL FUNCTIONS : · Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs. · Conducts and oversees concurrent and retrospective reviews for all patients. · Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process. · Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs. · Collaborates with ancillary services in order to prevent delays in services. · Evaluates the UM program for compliance with regulations, policies and procedures. · May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues. · Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation. OTHER FUNCTIONS : · Perform other functions and tasks as assigned.
Requirements
- Bachelor's degree in nursing or another clinical field required.
- Six or more year's clinical experience with the population of the facility preferred.
- Four or more years’ experience in utilization management required.
- Three or more years of supervisory experience required.
- If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
Nice To Haves
- Master's degree in clinical field preferred.
Responsibilities
- Monitor utilization of services
- Optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs
- Conducts and oversees concurrent and retrospective reviews for all patients
- Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process
- Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs
- Collaborates with ancillary services in order to prevent delays in services
- Evaluates the UM program for compliance with regulations, policies and procedures
- May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation
- Perform other functions and tasks as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
5,001-10,000 employees
