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)
Department: Utilization Review
Work Hours: Primarily Monday through Friday, extended hours as needed to support organizational operations.
This position is responsible for implementing and leading the Heritage Valley Health System’s Utilization Management, Case Management and Clinical Documentation programs in accordance with the mission, vision, values and strategic imperatives of the organization, federal and state law and regulations, and accreditation standards. Demonstrate proven results in improving clinical documentation, resource utilization management, case management to include transitions of care and other work processes related to the hospital stay and discharge planning.
Qualifications:
Required: Bachelor’s Degree in nursing or other health related field; Current PA RN licensure; Demonstrated knowledge and experience applying Utilization Management, Case Management and Clinical Documentation principles in a hospital setting; Proficient in the use of Microsoft computer applications; Knowledge of federal and state regulations and accreditation agencies; Successful completion of Acts 73 and/or 169 clearances within 90 days of commencing employment, if applicable.
Preferred:
Masters Degree in a health related field; Six Sigma training. Management experience in a health care setting.