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)
Utilization Review Director
Join a team that CARES! Here at ODMHSAS, we believe in I.C.A.R.E. – Integrity, Compassion, Accountability, Respect, and Excellence. Our mission is to promote healthy communities and provide the highest quality care to enhance the well-being of all Oklahomans. We take that very seriously – because we care!
About the Position: The individual selected for this position will plan, coordinate, and facilitate utilization review activities at several facilities across the state. This position would monitor the 60-day Medicaid benchmark, provide direction & guidance to UR Coordinators, standardize UR procedures, align internal policies & practices with TJC/CMS standards, and assist with staff transitions or shortages in UR departments. This position will be based at Griffin Memorial Hospital but will also oversee UR departments at Tulsa Center for Behavioral Health and Northwest Center for Behavioral Health.
Job Type/Salary:
Education & Experience Required:
Education and Experience requirements at this level consist of a bachelor’s degree in public, health or business administration or a closely related field and two years of professional experience in casualty insurance business management, fiscal management, underwriting, safety/loss prevention, actuary, claims management, claims investigation, claims adjustment, or group insurance benefits management; or an equivalent combination of education and experience, substituting one year of additional qualifying experience for each year of the required education.
Knowledge, Skills, & Abilities:
Knowledge, Skills and Abilities required at this level include knowledge of the principles and practices of supervision; of agency, state and industry rules and guidelines relevant to agency operations; and of principles and methods of program evaluation. Ability is required to supervise personnel; to maintain positive working relationships; to communicate effectively, both orally and in writing; and to implement policies, procedures and programs.
Great Reasons to Work for Us:
ODMHSAS is proud to provide a comprehensive benefits package designed to support our employees and their dependents. Our benefits include:
About us:
Griffin Memorial Hospital (GMH) is located in Norman, Oklahoma, and serves all 77 counties in Oklahoma as a Department of Mental Health and Substance Abuse Services (ODMHSAS) treatment center for adults. Griffin Memorial Hospital is a 120-bed acute psychiatric hospital serving persons aged 18 and over with severe mental illness and provides in-patient hospital care for those in need of mental health & substance abuse services.
Reasonable accommodation to individuals with disabilities may be provided upon request.
An Equal Opportunity Employer.
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