Utilization Management Director jobs in Alaska
Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Utilization Management Director jobs
System Director of Utilization Review
- Southeast Alaska Regional Health Consortium
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Juneau, AK
FULL_TIME
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Pay Range:$47.91 - $61.29SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.This position oversees the coordination of inpatient care services including Utilization Review, Case Management/Discharge Planning, and Social Services. This position develops and integrates strategies to enhance the quality of care for patient satisfaction, and healthcare outcomes.
At MEMC, this position could include a grant-funded Psychiatric Emergency Services (PES) program.Key Essential Functions and Accountabilities of the Job- Responsible for directing a system-wide utilization review process, including Case Management and Social Services, in multiple locations.
- Must be able to understand and manipulate advanced systems and work with and synthesize large relational data sets, providing descriptive/predictive/prescriptive analytics to support operational behavior modification.
- Meet and exceed department service, operational and financial goals, provide analysis, identification of variances and develop action plans to achieve established goals. Report unit performance to internal stakeholders as required.
- This position works intensively with advanced systems to track and trend denials, builds models for documentation improvement plans, and coordinates with all areas and levels of Southeast Alaska Regional Health Consortium (“SEARHC”) Hospitals.
- Work closely with revenue cycle and other finance staff to maximize revenues while maintaining compliance with regulations affecting utilization management. The position requires close interaction with and knowledge of the Medicare and Medicaid programs and other third-party payers.
- This position works closely with the provider community to improve clinical documentation and with administration to ensure appropriate hospital resource use. Care coordination includes the internal collaboration with the SEARHC Primary Care Clinics and Long-Term Care facilities. External collaboration includes tertiary care, assisted living, and psychiatric facilities.
- Direct the Utilization Review Department and ensure safe, efficient, and effective utilization of hospital facilities and services.
- Maintain compliance with all regulations.
- Participate in the development and implementation of departmental policies and procedures, and monitor/ensure compliance and consistency.
- Review and revise workflows and procedures to ensure maximization of resources and excellence in customer service.
- Chair the Utilization Review Committee. Coordinate and attend all Quarterly Utilization Review meetings and provide information and data relative to the review process and any identified problems.
- Works collaboratively with Physician Advisor and provider teams to ensure the appropriateness and necessity of an individual’s admission to or continued stay in hospital.
- Monitor quality measures, collecting and analyzing data to improve utilization of services and the effectiveness and appropriateness of support services.
- Oversee and support the psychiatric emergency service clinicians who assist the Emergency and Inpatient departments in patient assessments and recommendations to care team.
- Ensure timely and appropriate maintenance of records, with documentation of services provided and progress consistent with the care plan.
Education, Certifications, and Licenses Required- Bachelor’s degree from an accredited school required.
- Higher level of education preferred.
- Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required. Direct Hire must have applied for an Alaska nursing license before start date. Agency staff must have an active Alaska license.
- High school diploma or equivalent required.
Experience Required- Prior experience in the utilization and review function required.
- Previous management experience in supervision or administration required.
- Prior experience working in a Critical Access Hospital model preferred.
- Five years of clinical experience preferred.
- Prior experience in Performance Improvement preferred.
Knowledge of- Knowledge of health care service delivery systems and third-party reimbursement; knowledge of managed care environment.
- Solid understanding of healthcare, federal, and state regulations.
- Understanding of admission and discharge functions.
- Familiarity with medical terminology, diagnostic terms, and treatment modalities.
Skills in- Strong interpersonal, organizational, evaluative, and time management skills.
- Policy interpretation skills; familiarity with applicable standards and regulations.
- Provider communication and behavior change can be challenging; this individual must be an expert communicator and change agent.
- Responsiveness to deadlines; assertiveness, persistence, and persuasiveness.
Ability to- Ability to apply and interpret admission and continued stay criteria.
- Ability to organize tasks related to the accomplishment of hospital goals and objectives.
- Ability to work in a professional manner with physicians, outside agencies, and support staff.
- Ability to travel to multiple locations.
Required Certifications:Registered Nurse License - State of Alaska - Alaska State Board of NursingIf you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! -
- 18 Days Ago
Director of Grant Acquisitions and Management
- Qawalangin Tribe of Unalaska
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Anchorage, AK
FULL_TIME
- About Us Located on the Island of Unalaska, in the state of Alaska, the Qawalangin Tribe of Unalaska, a federally recognized sovereign nation, vows to exercise its powers to further the economic and s...
- 3 Days Ago
Director Case Management
- Alaska Regional Hospital
-
Anchorage, AK
FULL_TIME
- This position is incentive eligible. Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Director Case Management with Alaska Reg...
- 4 Days Ago
Affordable Community Director - Non-Exempt (REF3504I)
- FPI Management
-
Anchorage, AK
FULL_TIME
- Company DescriptionFPI Management, a national leader in property management, has an exciting opportunity for an experienced Community Direction to join our team at Chester Creek Estates, a 100 unit Se...
- 20 Days Ago
Community Director - NE (REF4836C)
- FPI Management, Inc.
-
Wasilla, AK
FULL_TIME
- Company DescriptionMultifamily Property ManagementJob DescriptionThe Community Director (Non-Exempt) is fully accountable for all day-to-day operations of a typically small asset/property (totaling le...
- 6 Days Ago
Affordable Housing Community Director - Non-Exempt (REF4944T)
- FPI Management, Inc.
-
Palmer, AK
FULL_TIME
- Company DescriptionMultifamily Property ManagementJob Description• Property Name: Breezy Meadow • 12821 Scott Rd, Palmer, AK 99645, USA • Full-Time • Unit Count: 16The Community Director (Non-Exempt) ...
- 2 Days Ago
Utilization Management Director jobs at Popular Companies
Managing Director
- Principal Financial Group
-
Miami, FL
- Managing Director - Miami; Principal Financial Network 42364 Sales Regular Full-Time Miami, Florida No A048000-West Cent...
- 6/11/2024 12:00:00 AM
Managing Director, Conflict Management & Dispute Resolution
- Dallas College
-
Dallas, TX
- Position Summary The Managing Director of Conflict Management & Dispute Resolution will be responsible for effectively d...
- 6/10/2024 12:00:00 AM
Managing Director, Business Management
- Applied Materials
-
Santa Clara, CA
- Managing Director, Business Management page is loaded Managing Director, Business Management Apply locations Santa Clara...
- 6/10/2024 12:00:00 AM
Managing Director
- Experis
-
Winston-Salem, NC
- Build your career with Experis, a ManpowerGroup company as we connect human potential to the power of business. Through ...
- 6/9/2024 12:00:00 AM
Managing Director / Senior Managing Director - Debt Advisory
- Oberon Securities, LLC
-
New York, NY
- Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
- 6/8/2024 12:00:00 AM
Managing Director Investment Management
- Leadenhall Search & Selection
-
- Leadenhall Search & Selection are currently recruiting for Directors and Partners on behalf of a global, fast-growing In...
- 6/8/2024 12:00:00 AM
Senior Relationship Manager - Director - Managing Director
- Deutsche Bank
-
Miami, FL
- Job Description: Job Title Relationship Manager Corporate Title Director to Managing Director Location Miami, FL Overvie...
- 6/7/2024 12:00:00 AM
SVB - Managing Director- Relationship Management- Fund Banking
- First Citizens Bank
-
Boston, MA
- Overview: Together, Silicon Valley Bank and First Citizens offer you the strength and stability of a diversified financi...
- 3/29/2024 12:00:00 AM
About Alaska
Alaska is the northernmost and westernmost state in the United States and has the most easterly longitude in the United States because the Aleutian Islands extend into the Eastern Hemisphere. Alaska is the only non-contiguous U.S. state on continental North America; about 500 miles (800 km) of British Columbia (Canada) separates Alaska from Washington. It is technically part of the continental U.S., but is sometimes not included in colloquial use; Alaska is not part of the contiguous U.S., often called "the Lower 48". The capital city, Juneau, is situated on the mainland of the North American ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$138,448 to $187,210
Most Popular Cities in Alaska for Utilization Management Director Jobs
What does a Utilization Management Director do?
Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
February 09, 2020
Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
February 18, 2020
Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019