Utilization Management Director jobs in Washington
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
Director Utilization Management
- Virginia Mason Franciscan Health
-
Bremerton, WA
FULL_TIME
-
Overview
Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington, our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers.
At Virginia Mason Franciscan Health, you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!
Responsibilities
Job Summary / Purpose
The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops strategies to achieve departmental and CommonSpirit Health goals and objectives.
This position directs the UM staff to meet or exceed operational performance standards. The Director oversees development and implementation of UM policies, procedures and processes; directs and assists with accreditation activities; efficient management of payer requirements, addressing denials effectively, and compliance with payer and regulatory requirements, and reviews and analyzes UM program outcomes and quality metrics.
Essential Key Job Responsibilities- Manages programs that emphasize appropriate admissions, concurrent and retrospective review of care, and concurrent denials
- Provides overall direction, design, development, implementation and monitoring of utilization programs to meet the Care Coordination goals and market utilization management goals while maintaining stakeholder satisfaction.
- Acts as a resource to the medical staff, administrative staff, divisional staff, as well as external regulatory agencies in all issues relating to utilization management within the Market.
- Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental, Utilization Management, Revenue Cycle, Payer Strategy, and Clinical Joint Operating Committees.
- Participates in the development and management of department budgets and productivity targets.
- Assures compliance with Federal, State, The Joint Commission (TJC), Det Norske Veritas (DNV), and other regulatory agencies and internal standards and requirements
- Collaborates with Physician Advisory Services to identify denial root causes related to physician performance and facilitates educational training for medical staff on issues related to utilization management.
- Implements utilization review policies and procedures.
- Directs recruitment, performance management, coaching, mentoring, training and development. Educates and trains staff on utilization review processes and guidelines.
- Promotes collaborative practice with revenue cycle stakeholders and facilitates data sharing that provides insight into where best to focus concentrated denial prevention and management efforts designed to reduce costly delays in payment and maximize claims reimbursement revenue.
- Shall be able to effectively monitor, evaluate and administer the resources of each assigned area, and make substantiated recommendations regarding resource allocation needs for future planning purposes.
- Collaborates with division and system leadership, revenue cycle, and other stakeholders to ensure achievement of denial reduction and value capture goals.
Job Requirements:
Education and Experience:
Required:- Bachelor’s degree in Nursing, Health Care Administration or advanced clinical degree.
- Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination)
- 5 years of progressively responsible management experience
- Extensive operational experience in managed care; extensive experience in program planning, implementation, staff development, and needs assessment
- Comprehensive knowledge of utilization management, financial management that includes revenue cycle, Medicare, Medicaid, and commercial admission and review requirements.
- Master’s degree in Nursing, Health Care Administration or related clinical field
- Experience with data analytics to include cost containment, over/under utilization assessment and clinical outcomes
- Experience with DRG, reimbursement, pricing and coding processes for inpatient and outpatient services
Current unrestricted licensure as a Registered Nurse in the state of Washington
National certification of any of the following: CCM (Certified Case Manager), ACM (Accredited Case Manager) required or within 2 years upon hire.
Pay Range
$56.83 - $82.40 /hour - 18 Days Ago
Director Utilization Management
- CommonSpirit Health
-
Bremerton, WA
FULL_TIME
- Overview* Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state CHI Franciscan and Virginia Mason. As one integrated health system with the most patient...
- 18 Days Ago
Utilization Management Coordinator I
- CHPW Careers
-
Seattle, WA
FULL_TIME
- This position is fully remote in Washington State only. Who we are Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified ap...
- 3 Days Ago
Utilization Management Specialists- 225668
- Medix™
-
Everett, WA
FULL_TIME
- This is a REMOTE opportunity for anyone with Utilization Management experience with benefits and weekly pay!!The Utilization Management Specialist implements, maintains and executes procedures and pro...
- 1 Day Ago
Utilization Management Coordinator (PRN)
- Smokey Point Behavioral Hospital
-
Marysville, WA
OTHER
- Job Details Level: Experienced Job Location: Smokey Point Behavioral Hospital - Marysville, WA Position Type: Per Diem Education Level: 4 Year Degree Salary Range: $30.00 - $30.00 Hourly Job Shift: Da...
- 16 Days Ago
Utilization Management Coordinator
- Fairfax Behavioral Health
-
Kirkland, WA
FULL_TIME
- Responsibilities: Quality healthcare is our passion, improving lives is our reward. Join us as we work to change lives and transform the delivery of healthcare. The Utilization Management Coordinator ...
- 24 Days Ago
Utilization Management Director jobs at Popular Companies
Managing Director
- Principal Financial Group
-
Miami, FL
- Managing Director - Miami; Principal Financial Network 42364 Sales Regular Full-Time Miami, Florida No A048000-West Cent...
- 6/11/2024 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
- Selby Jennings
-
Miami, FL
- Are you passionate about driving impactful change in infrastructure and sustainability? Do you thrive in dynamic environ...
- 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
About Washington
Washington (/ˈwɒʃɪŋtən/), officially the State of Washington, is a state in the Pacific Northwest region of the United States. Washington is the northwestern-most state of the contiguous United States. It borders Idaho to the east, bounded mostly by the meridian running north from the confluence of the Snake River and Clearwater River (about 116°57' west), except for the southernmost section where the border follows the Snake River. Oregon is to the south, with the Columbia River forming the western part and the 46th parallel forming the eastern part of the Oregon-Washington border. To the wes...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$137,049 to $185,319
Most Popular Cities in Washington 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