Utilization Management Director jobs in Allentown, PA

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)

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Utilization Management Specialist
  • Medix
  • Bethlehem, PA FULL_TIME
  • 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:

    • Provides compliant, accurate and timely delivery of appropriate Observation Notification directly to patients/families/representatives while hospitalized under Observation Status/Patient Class. Delivers other payer-based forms as warranted.
    • Documents all related information according to departmental policy and procedure. Prioritizes coverage at largest hospital site.
    • Ensures smooth utilization management department functioning which includes answering phones, communicating effectively and professionally through emails, relaying messages, printing documents from various electronic applications, and running daily reports.
    • Accurately processes and documents incoming and outgoing communication in all forms in the hospital EMR or payer-specific web-based systems.

    Minimum Qualifications:

    • Bachelor's Degree
    • 3 years Billing, health insurance, physician practice, case management, healthcare-related field, or equivalent operations.
    • Ability to complete data entry, communicate clearly & accurately both in written and verbal communication.

    #MEDIXCM

  • 22 Days Ago

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Director of Maintenance
  • Elm Management
  • Coopersburg, PA FULL_TIME
  • Now Hiring Full-time Director of Maintenance Competitive salary Medical / Dental / Vision insurance Generous paid time off (PTO) package and paid holidays 401(k) Weekly employee appreciation events; w...
  • 24 Days Ago

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Marketing Director
  • Elm Management
  • Coopersburg, PA FULL_TIME
  • Now Hiring! Mareketing Director Location: Coopersburg, PA Industry-leading pay rates 401(k) plan Comprehensive health insurance plan and supplemental insurance Dental and Vision insurance Generous pai...
  • 2 Days Ago

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Activities Director
  • Elm Management
  • Richland, PA FULL_TIME
  • Now Hiring Full-time Activities Director! Plan and oversee recreational events and programs. Create and lead activities like arts and crafts, music, dance, and sports to develop our resident’s social ...
  • 26 Days Ago

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Admissions Director
  • Elm Management
  • Allentown, PA FULL_TIME
  • Why work as the Admissions Director at Valley Manor Rehabilitation and Care Center? Competitive salary and benefits package 401(k) plan Generous paid time off (PTO) package and paid holidays We are an...
  • 18 Days Ago

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Director of Rehabilitation (DOR)
  • Elm Management
  • Coopersburg, PA FULL_TIME
  • Now Hiring Director of Rehabilitation! Competitive salary 401(k) Health/dental/vision insurance Generous paid time off (PTO) package and paid holidays Comfortable staffing ratios A clean environment a...
  • 19 Days Ago

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0 Utilization Management Director jobs found in Allentown, PA area

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Managing Director Staffing Services
  • EMPLOYVISION INC
  • Somerset, NJ
  • Job Description Job Description Title: Managing Director - Staffing Services Location: Somerset, NJ (Minimum 3 days from...
  • 3/29/2024 12:00:00 AM

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Global Program Manager, Director
  • Pfizer, Inc.
  • Collegeville, PA
  • In some instances a PM may provide leadership in the following areas:Alliance Programs and Business Development May lead...
  • 3/29/2024 12:00:00 AM

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Director, Product Management
  • Prudential
  • Dresher, PA
  • Job Classification: Product Management - Product Management At Prudential, we believe talent is key to achieving our vis...
  • 3/29/2024 12:00:00 AM

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Project manager/Forman/Laborer
  • Pittman Family Construction Llc
  • Quakertown, PA
  • Job Description Job Description Looking for Project manager/ Director of operations/ supervisor/ laborer Pay based on ab...
  • 3/29/2024 12:00:00 AM

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Admin Director Human Resources
  • Hunterdon Healthcare
  • Flemington, NJ
  • The Administrative Director of Human Resources is a strategic partner to the Chief Human Resources Officer and other lea...
  • 3/28/2024 12:00:00 AM

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Business Valuation Manager / Director
  • Xplora Search Group
  • Plymouth Meeting, PA
  • *Manager OR Director of Business Valuation* A highly respected advisory firm local to the Philly region is seeking a Man...
  • 3/27/2024 12:00:00 AM

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Managing Director, Client Strategy
  • Pitcairn Trust Company
  • Jenkintown, PA
  • Job Description Job Description Since 1923, Pitcairn has been a leading family office, helping many of America’s most su...
  • 3/27/2024 12:00:00 AM

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Vice President of Wealth Management
  • Leah Yosef International
  • Wayne, PA
  • Overview 10B+ AUM Wealth Advisory Firm seeks a Senior Wealth Advisor to inherit a book of 100m+ AUM and 30+ households f...
  • 3/27/2024 12:00:00 AM

Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$127,275 to $172,099
Allentown, Pennsylvania area prices
were up 1.5% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020