RN Director of Utilization Management

Healthcare Recruitment Partners

8d

About The Position

The RN Director of Utilization Management leads with executive presence, builds credibility with physicians, and holds the line where clinical judgment meets financial reality. The Director communicates and presents with the polish senior administration expects, and delivers a consistent record of results against goals. The RN Director thrives as a self starter, influencing physicians and peers without leaning on authority, adapting quickly to change, and navigating conflict with tact and diplomacy.

Requirements

• Registered Nurse (RN) required
• Bachelor Degree required
• Director of Utilization Management experience in an Acute Hospital Setting required

Nice To Haves

• Master Degree in Nursing or another health related field preferred
• Certification in Utilization Review or Case Management (CPUR/CCM/ACM) preferred

Responsibilities

• Directs day to day operations of the Utilization Management department, holding the work to payer requirements and regulatory standards
• Recruits, develops, and leads a high performing Utilization Management team aligned with hospital objectives
• Owns the departmental budget and staff allocation so productivity standards hold consistently
• Drives correct status assignment, fewer denials, and appropriate use of hospital resources
• Monitors key performance indicators, length of stay, and financial goals, then adjusts where the data points
• Partners with Physician Advisors on policy for status determination, medical necessity, denials and appeals, and physician education
• Serves as the liaison between clinical and financial operations, working with Case Management, Managed Care, Patient Financial Services, and Patient Access to keep the review process moving
• Educates and influences physicians, staff, and leadership on Utilization Review practice and on transitions of care
• Provides data driven insight and strategic recommendations to hospital leadership on Utilization Management performance
• Represents Utilization Management as the operational leader on committees covering resource utilization review, compliance, policy, and quality

What This Job Offers

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