Utilization Management Director Jobs

About The Position

Requirements

• Registered Nurse with Bachelor’s degree in Nursing and a minimum of 5 years clinical nursing experience OR Social Worker with Master’s degree in Social Work/Health-related field with a minimum of 5 years hospital work experience
• Minimum 5 years of healthcare management experience
• Able to demonstrate strong communication and interpersonal skills with ability to work effectively and collaboratively with nursing colleagues, physicians, administrators, and the entire healthcare team.
• Able to develop strong and productive working relationships with other leaders
• Able to teach/educate and motivate others
• Able to form strong team bonds and enhance team performance
• Strong organizational and quality management skills with ability to handle multiple, competing tasks and priorities
• Able to cope with rapidly changing information in a fast-paced environment
• Experience with computer technology, specifically experience with Windows based programs, e-mail, and Microsoft Word.
• For RNs - Registered Nurse licensed to practice in the Commonwealth of Virginia
• For Social Workers - Licensed Social Worker licensed to practice in the Commonwealth of Virginia.

Nice To Haves

• For RNs - Master’s degree in nursing/health-related field preferred
• Professional Nursing Leadership Certification (ANCC or AONL), or content expert certification preferred.

Responsibilities

• Directs all aspects (planning, priority setting, coordination, implementation, and evaluation) of the Care Coordination Model to improve length of stay performance and patient throughput of the organization, to include the following: Throughput and Patient Placement, Care Management for Patient Progression and Revenue Cycle, Care Coordination Center Operations and Leadership, and Organizational Metrics/Measures of Success
• Collaborates with corporate, hospital, and department leaders to implement Care Coordination Model roles, standard operating procedures (SOPs), Care Logistics operating system software, SNAP and Escalation Huddles, and Operational Rounding Program.
• Consults, coordinates, and educates the medical staff and healthcare team on issues of appropriate placement, utilization of resources, pre-certification and payer requirements, government regulations and appropriate levels of care.
• Ensures patient care coordination plans and activities comply with established policies and procedures, standards of care, regulatory requirements, budgetary parameters, and strategic objectives.
• Supports and fosters a commitment to continuous performance improvement by providing a coordinated system for evaluating patient care outcomes, quality measures, and key performance measures.
• Serves as throughput and efficiency Deployment Leader for Operational Rounding Program; creates and supports Executive Plan (A3) and identifies/aligns on critical outcomes for the organization and leading processes to drive outcomes.
• Participates in the development, review, and revision of policies and procedures consistent with the institutional practice and Care Coordination Model
• Interviews, hires, develops, counsels, and evaluates Clinical Care Coordination staff to maintain highly competent, mission-oriented, and values-driven team.
• Develops staffing guidelines that support Care Coordination Model, current budget, and external benchmarks
• Other duties as assigned

Benefits

• equitable and transparent compensation practices