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)
Medix is currently hiring for an Utilization Management Specialist for a Hosptial system in Bethlehem, PA. This position is fully onsite at the hospital. The UM Specialist will assist Utilization Management (UM) team by acting as a bridge between the patient/family/representative and the UM team, as well as the Interdisciplinary team for the purposes of communication related to health insurance communication, requirements and related information. The hours for the role: Monday-Friday 8am-4:30pm.
Overview:
Responsible for the compliant, accurate and timely delivery of Observation Notifications directly to patients and/or their families/representatives while hospitalized under Observation Status/Patient Class. Responsible for other payer-based forms, including but not limited to ADAR forms. Prioritizes coverage at largest hospital site. Works highly collaboratively with the IP Care Management team on-site. Also responsible for working collaboratively with UM teammates to perform administrative and operational functions within the UM Department. Provides support to UM teammates by ensuring appropriate communication with insurance payers as well as related documentation within payer-specified timeframes. Performs clerical duties including but not limited to: Notification of Admission of hospitalizations, faxes
Job Duties:
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0 Utilization Management Director jobs found in Allentown, PA area