Utilization Management Director jobs in Florida
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
Supervisor, Utilization Management
- Centene Management Company LLC
-
Remote-FL, FL
FULL_TIME
- You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. THIS POSITION IS REMOTE/WORK FROM HOME, NO TRAVEL, SUPPORTING A MARKET PLACE UTILIZATION MANAGEMENT TEAM. APPLICANTS MUST BE ABLE TO WORK EITHER CENTRAL TIME ZONE OR EASTERN TIME ZONE HOURS. THIS POSITION IS BONUS ELIGIBLE. Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards Collaborates with utilization management team to resolve complex care member issues Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards Assists with onboarding, hiring, and training utilization management team members Leads and champions change within scope of responsibility Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4 years of related experience. Knowledge of utilization management principles preferred. Previous people leadership experience preferred. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $72,400.00 - $130,100.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email recruiting@centene.com. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.
- 2 Days Ago
Utilization Management RN Reviewer
- Cleveland Clinic Health System
-
Martin, FL
PART_TIME
- At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the pa...
- 1 Day Ago
Utilization Management Registered Nurse
- Humana
-
Tampa, FL
FULL_TIME
- Become a part of our caring community and help us put health first Utilization Management Nurse -Front End Review utilizes clinical nursing skills to support the coordination, documentation and commun...
- 2 Days Ago
Utilization Management RN Reviewer
- Cleveland Clinic
-
Stuart, FL
FULL_TIME
- Join Cleveland Clinic’s Martin North Hospital where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are family. This downtown Stuart hospital...
- 2 Days Ago
Utilization Management Nurse
- Actalent
-
SUNRISE, FL
OTHER
- Utilization Management NurseJob DescriptionIn this role, you will be responsible for reviewing requests for service authorizations to assist with utilization of appropriate medical services. These rev...
- 3 Days Ago
Utilization Management Coordinator
- YesCare
-
Bartow, FL
FULL_TIME
- Licensed Registered Professional Nurse currently registered to practice in state of facility. Minimum of five (5) years prior hospital experience with five (5) years corrections experience Minimum of ...
- 3 Days Ago
Utilization Management Director jobs at Popular Companies
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, 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
- 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
- NEWMARK
-
Dallas, TX
- Job Description Newmark (NMRK) is one of the world's leading commercial real estate advisory firms. We provide a fully i...
- 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 Florida
Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$120,776 to $163,314
Most Popular Cities in Florida 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