Salary Company Skills How To Become Job Openings

Utilization Management Director jobs in Texas

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

P
Director of Utilization Review and Care Management
  • Parkland Health and Hospital System
  • Dallas, TX FULL_TIME
  • Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
    Primary Purpose


    Directs the Clinical Resource Management department to include the Utilization Management (UM) plan and associated programs to impact resource management and compliance of all state, federal and accreditation requirements.
    Minimum Specifications
    Education
    • Must have a Bachelor’s degree in Nursing, Health Administration, Public Health or Business Administration.

    Experience
    • Must have eight years of progressively responsible experience in a hospital or health program to include five years of leadership experience in Utilization Review or Care Management.

    Equivalent Education and/or Experience
    • None

    Certification/Registration/Licensure
    • RNs Only: Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
    • RNs Only: Must maintain current healthcare provider CPR course completion card.
    • Must have current healthcare provider BLS for Healthcare Providers certification from one of the following:
      • American Heart Association
      • American Red Cross
        • Military Training Network
    Required Tests for Placement
    • None

    Skills or Special Abilities
    • Must demonstrate understanding and use of statistics.
    • Must demonstrate ability to navigate and master proprietary software programs.
    • Must demonstrate ability to read and interpret documents.
    • Must have excellent verbal and written communication skills and writing skills to include good grammar.
    • Must have strong analytical skills.
    • Must demonstrate ability to use a personal computer including knowledge of Microsoft office products.
    • Must have effective leadership skills and be capable of motivating, recruiting and educating staff.
    • Must be able to demonstrate knowledge of Parkland policies, structure, procedures and mission within three months of employment.
      • Must demonstrate patient centered/patient valued behaviors.
    Responsibilities
    • Directs the day-to-day activities of Utilization Review and Care Management departments, to include the Utilization Management plan, to ensure effective and efficient operations and completion of all required functions and tasks with a focus on a customer service oriented work environment which meets the needs of staff, providers and patients.
    • Serves as the subject matter expert for the Utilization Management (UM) plan and as an advisor to the medical staff on resource management processes.
    • Works closely with the medical staff, Chief Medical Officer, Physician Advisors, and Care Coordination to appropriately manage resource utilization at Parkland.
    • Works closely with the data analytical team in the development of necessary reporting for Clinical Resource Management and effectively measures key outcomes.
    Responsible for effective fiscal management of the department. Prepares the annual budget, incorporating Parkland and Clinical Resource Management department goals. Periodically analyzes revenue and losses, revising budget, staffing, billing, facility access or other practices to accommodate cost effective findings. Ensures informed use of department resources through clear policies including equipment, supplies, personnel hiring/training practices and service utilization. Administers the operating, capital and payroll budgets to ensure that the department has the necessary funds to carry out the goals and objectives that have been established for the department. Complies with departmental budget requirements to control spending and develop the annual budget request.
    Job Accountabilities
    • Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
    • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
    • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
    • Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
    • Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
    • Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.
    Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.
  • 24 Days Ago
Apply this Job
U
Market Medical Director, Utilization Management - WellMed - Remote
  • UnitedHealth Group
  • San Antonio, TX FULL_TIME
  • Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for help...
  • 16 Days Ago
Apply this Job
W
Utilization Management/Utilization Review
  • Windmill Wellness Ranch LLC
  • Canyon, TX FULL_TIME
  • Windmill Wellness opened the Ranch in May of 2017. We are nestled in the Texas Hill Country and are sitting on 76 acres. The mission of Windmill Wellness Ranch Is to improve the physical, spiritual an...
  • 8 Days Ago
Apply this Job
K
LVN Utilization Review- Utilization Management
  • Kelsey-Seybold
  • Pearland, TX FULL_TIME
  • Responsibilities The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions ...
  • 7 Days Ago
Apply this Job
T
Utilization Management Coordinator - Bilingual
  • TenderHeart Health Outcomes
  • Austin, TX FULL_TIME
  • For nearly two decades, TenderHeart (formerly known as Longhorn Health Solutions) has been improving the lives of those we serve with high-quality incontinence care management. We start with each indi...
  • Just Posted
Apply this Job
K
Social Worker - Utilization Management
  • Knapp Medical Center
  • Weslaco, TX FULL_TIME
  • Social Worker - Utilization Management Facility Knapp Medical Center Location US-TX-Weslaco ID 2024-162797 Category Clinical Professional Position Type Per Diem Shift Variable Job Type Non-Exempt Over...
  • 9 Days Ago
Apply this Job
View All Utilization Management Director Jobs

Utilization Management Director jobs at Popular Companies

A
Managing Director
  • Asian Pacific Environmental Network
  • Oakland, CA
  • The Asian Pacific Environmental Network (APEN) was founded in 1993 to bring together a collective voice among the divers...
  • 6/2/2024 12:00:00 AM
Apply this job
K
Regional Utilization Management Director
  • Kaiser Permanente
  • Aurora, CO
  • Salary Range: $65.38/hour - $84.56/hour $60.53 - $71.20 Job Summary: Manages the overall, regionwide utilization managem...
  • 6/1/2024 12:00:00 AM
Apply this job
P
Risk Management Director - Asset Management
  • Principal Financial Group
  • Des Moines, IA
  • What You'll Do: Were looking for a Risk Management Director to join our Principal Asset Management team. In this role, y...
  • 6/1/2024 12:00:00 AM
Apply this job
M
Associate Program Management Director/Program Management Director
  • MacroGenics, Inc.
  • Rockville, MD
  • MacroGenics is a leader in the discovery and development of innovative medicines that utilize our next generation antibo...
  • 5/30/2024 12:00:00 AM
Apply this job
E
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 ...
  • 5/30/2024 12:00:00 AM
Apply this job
N
Managing Director
  • NEWMARK
  • Dallas, TX
  • Job Description Newmark (NMRK) is one of the world's leading commercial real estate advisory firms. We provide a fully i...
  • 5/30/2024 12:00:00 AM
Apply this job
O
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 ...
  • 5/29/2024 12:00:00 AM
Apply this job
L
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...
  • 5/29/2024 12:00:00 AM
Apply this job
View All Utilization Management Director Jobs

About Texas

Texas (/ˈtɛksəs/, locally /ˈtɛksɪz/; Spanish: Texas or Tejas Spanish pronunciation: [ˈtexas] (listen)) is the second largest state in the United States by both area and population. Geographically located in the South Central region of the country, Texas shares borders with the U.S. states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexican states of Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the southwest, while the Gulf of Mexico is to the southeast. Houston is the most populous city in Texas and the fourth largest in the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$124,187 to $167,923

Most Popular Cities in Texas 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