Utilization Management Director jobs in Grand Rapids, MI

About Corewell Health

Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value.​ Through compassion, collaboration, clarity, curiosity and courage, we make anything and everything possible.​ Through our people, we care for the whole person with respect, dignity and love. ​Everyone deserves opportunities and resources for better health.​ Everyone deserves our relentless pursuit to innovate and always do better. ​Everyone deserves to have a community be a great place to live, work, learn and play.​ We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. ​We believe that together we will make a difference.​ Together, we are here to make health better for everyone.​ Together, we are Corewell Health.

Scope of Work

Supervises assigned Utilization Management staff. Plans, organizes, and supervises all assigned clinical and program services. Ensures appropriate clinical supervision and case consultation for clinical staff including overseeing and supporting professional staff development. Supervises within established clinical quality standards and quality management plan protocols. Evaluates staff competencies and identifies training needs. Experience with Utilization Review of Inpatient or Inpatient appeal cases using InterQual and willing to back up to Peer to Peer triage and scheduling.

• Supervises the activities of assigned professional and support staff who are engaged in planning and prioritizing care for individuals and population of patients, focusing on strategies that will promote optimal health within populations. Supervises office operations assuring adequate levels of support for quality clinical care. Monitors clinical activity, staff productivity, and the efficiency an effectiveness of the services provided. Communicates & holds staff accountable to new policies/procedures. Prepares, maintains, and submits reports as required. Maintains files and records.
• Maintains professional relationship with providers when cases require referral for specialized treatment or to another level of care. Reports problems with providers to provider relations or management staff. Assures clinical staff compliance with credentialing requirements, and monitors utilization and referral patterns, clinical case loads and program needs.
• Anticipates customer needs and supervises the provision of services to all customers, including patients, physicians, hospital departments, and staff. Coordinates requests for services, information, records, and data on a timely basis. Researches and resolves problems.

How we will care for you, while you care for our patients

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

Qualifications

• Required Bachelor's Nursing Degree or equivalent Nursing experience Required.
• 1 year of relevant experience Skills, knowledge, abilities typically gained through 1 year of related experience Required
• 5 years of relevant experience full time clinical Required
• 1 year of relevant experience of clinical supervision and administrative management responsibility or equivalent Required

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CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.