Utilization Management Director jobs in Missouri
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
- Centurion Health
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JEFFERSON CITY, MO
OTHER
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Job Details
Job Location: MO, Jefferson City - Missouri Regional Office - JEFFERSON CITY, MOPosition Type: Per DiemEducation Level: Associate's DegreeSalary Range: UndisclosedTravel Percentage: NoneJob Shift: As NeededJob Category: Nursing Professional & SupportDescription
Centurion is proud to be the provider of comprehensive healthcare services to the Missouri Department of Corrections.
We are currently seeking a PRN Utilization Review Nurse to join our Missouri Regional Office Team located in Jefferson, Missouri.
The Utilization (UM) Nurse performs the review of requests for prior authorization of medical services, including diagnostic, outpatient care and services using defined criteria. Duties will include admissions though on-site and telephonic review to ensure medical necessity and appropriate level of care, review and audit of patient medical records as indicated to determine medical necessity, and serving as a clinical resource and liaison for site and hospital referral staff.
Qualifications
- MIssouri RN license or ability to obtain license
- Utilization management experience, InterQual experience preferred
- Two (2) years of clinical nursing experience and one year of experience in performing prior authorization review
- Experience using medical management software programs
- Experience working with a correctional institution or agency preferred
- Must be able to pass background investigation and obtain agency security clearance
PRN
We offer excellent compensation and comprehensive benefits for our full-time team members including:
- Health, dental, vision, disability and life insurance
- 401(k) with company match
- Generous paid time off
- Paid holidays
- Flexible Spending Account
- Continuing Education benefits
- Much more...
- 1 Month Ago
- SRZ Management
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Kansas, MO
FULL_TIME
- **SIGN ON BONUS OF $10,000*** Director of Nursing Position Summary: We are looking for an experienced Director of Nursing to organize and oversee all nursing operations of the facility. You will creat...
- 1 Month Ago
- OPCO Skilled Management
-
Independence, MO
FULL_TIME
- POSITION DESCRIPTION: Description Responsible for planning, organizing, and implementing a program of activity/leisure pursuits designed to meet the social, spiritual, intellectual, emotional, educati...
- 3 Days Ago
- Prime Healthcare Management
-
Lewistown, MO
FULL_TIME
- We are actively seeking a motivated Director of Rehabilitation (DOR) to join our in-house therapy team at Country Aire Retirement Center in Lewistown, Occupational Therapy Assistant Preferred! *DOR ex...
- 4 Days Ago
- Management & Training Corporation
-
St Louis, MO
OTHER
- OverviewWage - $80,000 annually (DOE)Schedule – Full Time, 8hr shifts, Monday – FridayOur Staff Also Enjoy These BenefitsHealth, dental, vision, prescription drug and life insurance401(k) retirement p...
- 7 Days Ago
- Management & Training Corporation
-
St. Louis, MO
FULL_TIME
- Overview Wage - $80,000 annually (DOE) Schedule – Full Time, 8hr shifts, Monday – Friday Our staff also enjoy these benefits: Health, dental, vision, prescription drug and life insurance 401(k) retire...
- 1 Month Ago
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-
New York, NY
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- Deutsche Bank
-
Miami, FL
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