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Utilization Management Director jobs in Montana

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

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Utilization Management Clinician - Behavioral Health
  • PacificSource
  • Helena, MT FULL_TIME
  • Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services. Facilitate outstanding member care using fiscally responsible strategies. Essential Responsibilities: Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. Coordinate necessary resources to achieve member outcome goals and objectives. Accurately document case notes and letters of explanation which may become part of legal records. Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs. Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care. Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions. Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets. When applicable, identify and negotiate with appropriate vendors to provide services. When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development. Work with multidisciplinary teams utilizing an integrated team-based approach to best support members, which may include working together on network not available (NNA), out of network exceptions (OONE), and one-time agreements (OTA). Serve as primary resource to member and family members for questions and concerns related to the health plan and in navigating through the health systems issues. Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients. Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines and procedures for Health Services Department. Supporting Responsibilities: Act as backup and be a resource for other Health Services Department staff and functions as needed. Serve on designated committees, teams, and task groups, as directed. Represent the Heath Services Department, both internally and externally, as requested by Medical Director. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. Work Experience: Five years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required. Experience in acute care, case management, including cases that require rehabilitation, home health, behavioral health and hospice treatment strongly preferred. Insurance industry experience helpful, but not required. Education, Certificates, Licenses: Registered Nurse or a Clinically Licensed Behavioral Health Practitioner with current unrestricted state license. Within 6 months of hire licensure may need to include Oregon, Montana, Idaho and/or other states as needed. Case Manager Certification as accredited by CCMC preferred. Knowledge: Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance and state-mandated benefits. Understanding of contractual benefits and options available outside contractual benefits. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of appropriate case management plans. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision. Must be able to function as part of a collaborative, cohesive community. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our 1,900 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance June 29: The Dalles, Pride Fair and Parade, 10a-5p (The Dalles, OR) PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2023 alone we had 407 internal promotions! Top Workplace 2024 USA | USA Today Certified Age Friendly Employer, 2023 | Age Friendly Institute Top Workplace 2023 and 2022 for Idaho | Idaho Press Top Workplace 2023 and 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HRrecruiting@PacificSource.com.
  • 11 Days Ago
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Healthcare Director Materials Management
  • Clinical Management Consultants
  • Fort Benton, MT FULL_TIME
  • This trusted and established Acute Care Hospital in Montana is actively interviewing for a Director of Materials Management to lead the Supply Chain and Logistics team. Apply today, and join a leaders...
  • 4 Days Ago
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Director of Product Management
  • DEER MANAGEMENT SYSTEMS LLC
  • Laurel, MT FULL_TIME
  • Job Title: Director of Product Management Company Overview: At Tactacam, we are a rapidly growing and market-leading outdoor products and technology company. With over 500,000 active customers worldwi...
  • 1 Month Ago
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Healthcare Director Materials Management
  • Clinical Management Consultants
  • Helena, MT FULL_TIME
  • This trusted and established Acute Care Hospital in Montana is actively interviewing for a Director of Materials Management to lead the Supply Chain and Logistics team. Apply today, and join a leaders...
  • 2 Months Ago
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HIM Director
  • Clinical Management Consultants
  • Savage, MT FULL_TIME
  • An amazing hospital in Montana state is looking for a HIM Director to join its team. In this beautiful part of Montana, this medical facility has everything that someone would want. Join today to make...
  • 6 Days Ago
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HIM Director
  • Clinical Management Consultants
  • Savage, MT FULL_TIME
  • An amazing hospital in Montana state is looking for a HIM Director to join its team. In this beautiful part of Montana, this medical facility has everything that someone would want. Join today to make...
  • Just Posted
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Utilization Management Director jobs at Popular Companies

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RN Registered Nurse - Orthopedics & Neurology
  • Ascension
  • Grand Blanc, MI
  • Details Sign-on bonus: $7,500.00 Department: Orthopedics & Neurology Schedule: Full Time Days 7 am - 7:30 pm, Friday, Sa...
  • 6/10/2024 12:00:00 AM
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Senior Manager / Associate Director - BI Consulting (Life Sciences/Pharma)
  • Tiger Analytics
  • Princeton, NJ
  • Tiger Analytics is an advanced analytics consulting firm. We are the trusted analytics partner for several Fortune 100 c...
  • 6/10/2024 12:00:00 AM
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Lead Interior Designer & Director of Design Team
  • Studio G Home
  • Sarasota, FL
  • Lead Interior Designer & Director of Design Teams About Studio G Home: At Studio G Home, our interior designers are eage...
  • 6/10/2024 12:00:00 AM
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Mental Health Counselor
  • New Priorities Family Services
  • Redmond, OR
  • This position includes the opportunity to work with a range of clientele. NPFS offers/encourages in-person therapy. Tele...
  • 6/10/2024 12:00:00 AM
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Director of Bioinformatics
  • Harnham
  • San Diego, CA
  • Director of Bioinformatics San Diego, CA (Hybrid) $200,000-$230,000 base Our client is seeking a highly skilled and moti...
  • 6/10/2024 12:00:00 AM
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Plant Operators/Plant Technician (Level I, II, II)
  • CenTrio
  • Job Title: Plant Operator (I, II, II) (Steam Station) Location: Baton Rouge (303 S. Stadium Drive, Baton Rouge, LA 70802...
  • 6/10/2024 12:00:00 AM
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Commercial Project Manager
  • Solar Alternatives
  • New Orleans, LA
  • Solar Alternatives is an award-winning leader in innovative energy technology and reliable, high standards service, engi...
  • 6/10/2024 12:00:00 AM
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Sales Development Manager
  • CORE Higher Education Group
  • West Warwick, RI
  • CORE Higher Education Group is looking to grow its Sales team by adding a Manager of Sales Development. This position le...
  • 6/10/2024 12:00:00 AM
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About Montana

Montana (/mɒnˈtænə/ (listen)) is a landlocked state in the Northwestern United States. Montana has several nicknames, although none are official, including "Big Sky Country" and "The Treasure State", and slogans that include "Land of the Shining Mountains" and more recently "The Last Best Place". Montana is the 4th largest in area, the 8th least populous, and the 3rd least densely populated of the 50 U.S. states. The western half of Montana contains numerous mountain ranges. Smaller island ranges are found throughout the state. In all, 77 named ranges are part of the Rocky Mountains. The easte...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$118,742 to $160,564

Most Popular Cities in Montana 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