Utilization Management Director jobs in Beaumont, TX

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)

B
Director of Benefits/Risk Management
  • Beaumont Indep School District
  • Beaumont, TX FULL_TIME
  •  

    Beaumont Independent School District

    Job Description

     

    JOB TITLE:

    Director of Benefits/Risk Management

    CLASSIFICATION:

    Exempt

    REPORTS TO:

    Chief Financial Officer

    PAY GRADE:

    ADM

    6

    / 235 Days

    LOCATION:

    Business Office

    DATE REVISED:

    11/06/2023

     

    PRIMARY PURPOSE:

     

    Plans, directs, and coordinates risk management and insurance programs to control risks and losses of the district and coordinates the employee benefits program to best serve individual benefits needs of our employees and the district as a whole.

     

    QUALIFICATIONS:

     

    Education/Certification:

    • Bachelor’s degree in business related field or comparable experience

     

    Special Knowledge/Skills:

    • Extensive organizational skills
    • Ability to work independently; excellent decision-making skills
    • Ability to interpret and implement insurance, district policies, procedures and legislation pertaining to benefits and risk management
    • Ability to interpret data
    • Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
    • Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
    • Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to members of the board of trustees, administrators, principals, staff, and insurance representatives
    • Proficiency in Microsoft Office products and database management
    • Knowledge of Texas Workers’ Compensation Code
    • Effective interpersonal skills
    • Ability to maintain a high level of confidentiality
    • Supervisory skills

     

    Experience:

    • Experience in customer service, benefits and risk management, property/casualty, commercial insurance, or a related field preferred 

    MAJOR RESPONSIBILITIES AND DUTIES:

     

    Risk Management

     

    1. Manages district's risk management policies and procedures.
    2. Coordinates and monitors the district property/casualty insurance program, including general liability, real property, automobile, school leaders' errors and omissions, underground storage tank, excess liability, inland marine, boiler and machinery, bonds, and police professional liability insurance.
    3. Coordinates with BISD's legal counsel to investigate and respond to all legal notices and claims, and ensures that payment is made for only those damages for which the district has a legal obligation.
    4. Surveys and conducts cost/benefit analysis of risk management insurance programs.
    5. Conducts risk management claims review and conflict/dispute resolution.
    6. Implements, coordinates and monitors loss control procedures for the district.
    7. Negotiates and manages contractual services for Third Party Administration, including unemployment compensation management.
    8. Creates, coordinates and monitors safety programs designed to ensure employee safety in the workplace.
    9. Implements and monitors an effective workers' compensation benefit program for district employees.
    10. Manages the district unemployment compensation program and participates in unemployment hearings conducted by the Texas Workforce Commission.
    11. Manages the district’s loss, damage, theft prevention and property recovery program.
    12. Investigates accidents for fact determination, recommends action for future prevention, makes reports available to district insurance carrier, and tracks recovery of insured losses and third-party subrogation.
    13. Develops, implements, and maintains automated database for incident reports, vehicle accident reports, burglary, vandalism, loss reports and workers' compensation losses.
    14. Determines loss trends and recommends pro-active loss prevention measures and implements those measures.
    15. Conducts periodic, unannounced inspections of district facilities to seek out and eliminate hazardous safety conditions.
    16. Assists with request for proposal (RFP) development and evaluation for the district’s workers’ compensation, real property, automobile, liability, and other insurance coverage products.
    17. Develops, implements and maintains the district’s workers’ compensation return-to-work program including program training for supervisors and employees, bona fide job offer development and limited duty work status monitoring for all applicable worker’s compensation claims.
    18. Coordinates directly with treating physicians, clinical staff personnel and other medical professionals to ensure quality treatment and that accurate duty restrictions identification occurs concerning injured BISD employees.

     

     

     

    Employee Benefits

    1. Manages the district's employee benefits policies and procedures.
    2. Surveys and conducts cost/benefit analysis of employee benefits programs.
    3. Facilitates employee benefits claims review and conflict/dispute resolution as required. Supervises benefits orientation meetings and enrollment of new employees in benefit plans.
    4. Coordinates the annual open enrollment process, including making group presentations and preparing, distributing, and receiving benefits material and enrollment forms.
    5. Coordinates and implements procedures to provide an efficient tax-sheltered annuity (403b and 457) investment programs for district employees.
    6. Negotiates and manages contractual services for Third Party Administration, including, but not limited to, COBRA/HIPAA compliance, 403(b) and 457 compliance, and cafeteria plan administration.
    7. Assumes primary responsibility for operation of the BISD cafeteria plan, as permitted under Section 125 of the Internal Revenue code, including employee health insurance, dental insurance, life insurance, long term disability and unreimbursed medical/dental/vision account benefits, or any other qualifying benefit approved by the board of trustees.
    8. Performs other duties as assigned.

     

    SUPERVISORY RESPONSIBILITIES:

     

       Directly supervises employees. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, recommending for hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

     

     

    EQUIPMENT USED:

    • Uses personal computer, printer, copier, calculator, scanner, fax.

    WORKING CONDITIONS:

     

    Mental Demands

    Ability to multitask; work with frequent interruptions; be a self-starter when need arises; ability to communicate effectively (orally and written); maintain emotional control under stress.

     

    Physical Demands

    Work with frequent interruptions. Frequent standing, stooping, bending, kneeling, pushing and pulling. Prolonged use of computer and repetitive hand motions. Occasional lifting up to 20 pounds. Occasional travel to various PISD sites.

     

     

     

    The above statements describe the general purpose and responsibilities assigned to the job and are not an exhaustive list of all responsibilities, duties, and skills that may be required.  This job description is not an employment agreement or contract.  The administration has the exclusive right to alter this job description at any time without notice.

     

     

    **The State Board for Educator Certification will require all first time applicants for an initial credential to be fingerprinted as part of a national criminal background check. A cost of up to $49. 00 will be charged for fingerprinting.

     

    Approved by Immediate Supervisor:

     

    Date:

    Reviewed by HR Director:

     

    Date:

    Received by Employee:

     

    Date:

     

  • 14 Days Ago

H
Director of Compliance/Risk Management
  • Harbor Healthcare System
  • Beaumont, TX FULL_TIME
  • We are currently seeking qualified candidates for a full time Director of Compliance/Risk Management position in the Beaumont area. Job Description: Provides guidance regarding State, Federal, and Loc...
  • 1 Month Ago

M
Director of Nursing
  • Management & Training Corporation
  • Livingston, TX FULL_TIME
  • Overview Rate of Pay: $84,000 Benefits include: Medical, vision, dental and prescription drug benefits Life, accidental death and dismemberment insurance Short-term and long-term disability benefits 4...
  • 1 Month Ago

C
Director Clinic Operations
  • Clinical Management Consultants
  • Livingston, TX FULL_TIME
  • An exciting opportunity for Director Clinic Operations has become available at an award-winning acute care hospital located in East Texas! This 131-bed acute care hospital values its commitment to exc...
  • 3 Days Ago

F
Food Service Director
  • Food Management Search
  • Orange, TX FULL_TIME
  • Compensation: $60,000 - $70,000 per year 10% BONUS The Food Service Director is a management position responsible for developing and executing dining solutions to meet customer needs and tastes. Overs...
  • 9 Days Ago

B
Restaurant management
  • Beaumont Foodie, LLC
  • Jasper, TX FULL_TIME
  • This means the independent franchisee, and not Jack in the Box Inc. will be your employer if you are hired. The independent franchisee is responsible for all employment-related matters in the restaura...
  • 22 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Utilization Management Director jobs found in Beaumont, TX area

C
Regional Director Quality Management
  • Christus Health
  • Beaumont, TX
  • Description Summary: In collaboration with other clinical leaders in the Regional Group, is responsible for ensuring tha...
  • 4/24/2024 12:00:00 AM

T
Heart Gallery Program Manager
  • Texas Family Care Network
  • Beaumont, TX
  • Job Description Job Description Position Summary The Heart Gallery Program Manager is responsible for leading the day-to...
  • 4/23/2024 12:00:00 AM

L
Department Head, Technical Services
  • Lamar University
  • Beaumont, TX
  • General Description: The Department Head, Technical Services, reporting to the Dean of the Library, is responsible for m...
  • 4/23/2024 12:00:00 AM

M
Director of Operations - Fun Concept - $80K plus bonus - Quick Apply!
  • Monica Bell Hospitality
  • Beaumont, TX
  • Job Description Job Description We are seeking a Restaurant Director Of Operations to become an integral part of our tea...
  • 4/23/2024 12:00:00 AM

C
Manager Laboratory, LAB Admingeneral - Full Time
  • Christus Health
  • Beaumont, TX
  • Description Summary: Responsible for one or more lab sections (histology, microbiology, phlebotomy, etc.). Establishes g...
  • 4/22/2024 12:00:00 AM

C
Physical Therapist Assistant, Home Health Full Time
  • CenterWell Home Health
  • Beaumont, TX
  • Become a part of our caring community and help us put health first As a Home Health Physical Therapist Assistant, you wi...
  • 4/22/2024 12:00:00 AM

H
Operations Director
  • Howard Energy Partners
  • Port Arthur, TX
  • Conducts and supervises all operations in a safe and efficient manner to ensure compliance with all applicable safety, e...
  • 4/21/2024 12:00:00 AM

C
Manager Medical Staff-Med Staff Admin-Full Time
  • Christus Health
  • Beaumont, TX
  • Description Summary: Provides leadership, management and operational oversight to the Medical Staff Services department....
  • 4/21/2024 12:00:00 AM

Beaumont (/ˈboʊmɒnt/ BOH-mont) is a city in and the county seat of Jefferson County, Texas, in the United States, within the Beaumont–Port Arthur Metropolitan Statistical Area. Located in Southeast Texas on the Neches River about 85 miles (137 km) east of Houston (city center to city center), Beaumont had a population of 117,267 at the time of the 2010 census, making it the thirtieth-most populous city in the state of Texas. Beaumont was founded as a town in 1835. The early European–American settlement had an economy based on the development of lumber, farming, and port industries. In 1892, Jo...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$122,134 to $165,149
Beaumont, Texas area prices
were up 1.2% 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