Manager of Utilization Management

EMPOWER HEALTHCARE SOLUTIONS•Little Rock, AR

1d•$1 - $1

About The Position

As the Manager of Utilization Management, you will play a critical role in overseeing and optimizing the utilization of healthcare resources within our organization. You will be responsible for assisting with the implementation of utilization management programs and development of strategies to ensure the efficient and cost-effective delivery of healthcare services while maintaining high-quality patient care. This position requires strong leadership skills, a deep understanding of healthcare regulations, and a commitment to achieving operational excellence.

Requirements

Bachelor's degree in healthcare administration, nursing, or a related field (master’s degree preferred).
Active licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), or related field required.
Minimum of 3-5 years of progressive experience in healthcare utilization management, and leadership role.
In-depth knowledge of healthcare regulations, including CMS guidelines and accreditation standards.
Strong analytical and data interpretation skills.
Excellent communication and interpersonal skills.
Ability to adapt to changing healthcare landscapes and regulations.
Medicaid experience in Arkansas.

Responsibilities

Program Development: Assist with design, development, and implementation of utilization management programs and policies to optimize resource utilization while ensuring high-quality care delivery.
Collaborate with clinical teams, including physicians, nurses, and other healthcare professionals, to establish utilization guidelines and protocols.
Oversee the third-party administrator of Utilization Management services to ensure all SLAs are met and services utilized efficiently.
Review and evaluate clinical data to identify potential areas for improvement in resource utilization.
Compliance and Regulations: Ensure compliance with healthcare regulations and accreditation standards related to utilization management.
Stay updated on changes in healthcare regulations and implement necessary adjustments to policies and procedures.
Stay informed about industry trends and emerging practices in utilization management through active engagement with external networks and organizations.
Data Analysis and Reporting: Utilize data analytics to track and analyze utilization patterns, identify trends, and develop strategies for improvement.
Generate reports and present findings to senior leadership and regulatory bodies as required.
Cost Control: Collaborate with finance and reimbursement teams to manage and control healthcare costs while maintaining high-quality care.
Implement cost-saving initiatives and monitor their effectiveness.
Quality Improvement: Work closely with quality assurance teams to ensure that utilization management processes contribute to improved patient outcomes and satisfaction.
Interdepartmental Collaboration: Foster collaboration with other departments, including case management, care coordination, and medical staff, to optimize patient care pathways.
External Collaboration: Establish and maintain effective working relationships with external healthcare organizations, payers, and providers to enhance coordination of care and utilization management efforts.
Collaborate with external partners to exchange best practices, benchmark performance, and explore opportunities for process improvement and cost-effective resource utilization.
Represent the organization in external meetings, forums, and committees related to utilization management and healthcare resource optimization.
Foster collaborative partnerships with external entities to ensure a seamless continuum of care for our members.
Other duties as assigned.