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)
Large managed care company is looking Utilization Management Specialists with great customer service skills to be answers referral and authorization inquiries from health plans, clinical areas, patients and outside office/facilities.
Work Location: 1800 41St Street, S-500, Everett, WA 98203
Pay: $22.00
Contract Dates: ASAP to 7/31/2024
Hours: Monday – Friday, 8-5:30 (40 hrs/wk)
JOB DESCRIPITON
The Utilization Management Specialist implements, maintains and executes procedures and processes by which Optum performs its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests when requested, to assist in review, processing, and coordination of prospective, concurrent and retrospective referrals.
RESPONSIBILITIES
QUALIFICATIONS
Job Types: Full-time, Contract
Pay: $22.00 per hour
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Work Location: In person
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