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)
The Director of Care Management works under the supervision of the Vice President of Nursing/ Chief Nursing Officer. As Director, the provisions of utilization review, case management services, social services discharge planning, and departmental responsibilities are assumed. The Director plans the scope of and directs the implementation of Care Management practice within Holzer Health System. The Director functions as a Case manager when staffing requires.
Education, Work Experience and Licensure:
• Graduate of an accredited School of Nursing. BSN required or to be obtained within 3 years of employment.
• Case Management certification encouraged.
• Previous work and management experience will be considered.
• Active nursing license recognized by the Ohio Board of Nursing
• A minimum of 3 years’ experience as a RN in acute care for adult and pediatric patients. Three years’ experience in Case Management and Utilization Review.
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