Utilization Management Director jobs in Johnstown, 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)

Recently Added Utilization Management Director jobs

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Utilization Management, RN, IN - Remote
  • McLaren Health Care
  • Indiana, PA FULL_TIME

  • We are looking for a Utilization Management, RN - IN to join us in leading our organization forward.

    McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. 

    McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.   As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

    McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members.  Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

    MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.  Learn more about MDwise, Inc. at https://www.mdwise.org/

    Position Summary:

    This position is responsible for utilization management functions.  This includes but is not limited to review and authorization of services, utilization of medical policy, utilization of standard screening techniques, and utilization of behavioral change techniques.  Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Performs as the member advocate with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member’s utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects.

    This is a fully remote position.

    Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

    #LI-AK1

    Qualifications:

    Required:

    • RN with a valid unrestrictive license from state employed in state providing services.
    • Two (2) years clinical nursing experience.
    • One (1) year previous experience in Managed Care Utilization Management, Medical Management, Case Management.

       Preferred:

    • Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
    • Two (2) years’ experience in Managed Care Utilization Management, Medical Management, Case Management
    • BSN
    • Certified Case Manager (CCM) Certification.
    Additional Information
  • 1 Day Ago
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Director of Risk Management/Compliance
  • Mountain Laurel Medical Center
  • Oakland, MD OTHER
  • Job Details Job Location: Oakland Office - Oakland, MD Position Type: Full Time Education Level: 4 Year Degree Salary Range: Undisclosed Job Shift: Day Job Category: Management DescriptionUnder the su...
  • 10 Days Ago
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Food Service Director
  • Pollak Innovative Management Partners
  • Johnstown, PA FULL_TIME
  • COVID VACCINE IS REQUIRED Food Service Director Benefits Health Dental Vison The Food Service Director plans, organizes, develops, and directs the overall operation of the Culinary and Nutritional Dep...
  • 17 Days Ago
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Management
  • Dairy Queen Grill & Chill
  • Johnstown, PA FULL_TIME
  • •Hire, train, coach and develop the store management team and hourly crew members to build a highly skilled and productive team •Create and maintain a positive, safe, clean, and inviting environment f...
  • 1 Month Ago
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Director
  • Mountain Laurel Learning Center
  • Thomas, WV FULL_TIME
  • ABOUT US: The Mountain Laurel Learning Cooperative (MLLC) is a non-profit educational organization committed to the mission of inspiring children to become joyful, life-long learners and engaged, comp...
  • 1 Month Ago
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Retail management
  • GameStop
  • Cumberland, MD FULL_TIME
  • PLEASE NOTE : Your application will be considered for all locations within this district. Our passion around delighting our customers is our singular mission. We are simply obsessed with it. It’s what...
  • 5 Days Ago
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0 Utilization Management Director jobs found in Johnstown, PA area

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Facilities Management Director
  • Encompass Health
  • Altoona, PA
  • The Facilities Management Director is responsible for ensuring that the company Rehabilitation Hospital, satellite clini...
  • 4/25/2024 12:00:00 AM
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Hy-Vee Wine and Spirits Department Manager
  • Hy-vee Inc
  • Altoona, PA
  • Hy-Vee Wine and Spirits Department Manager page is loaded Hy-Vee Wine and Spirits Department Manager Apply locations Alt...
  • 4/23/2024 12:00:00 AM
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Lead Student Worker -- IUP Dining -- North Dining
  • Aramark Corp.
  • Indiana, PA
  • Job Description The Lead Student Worker is responsible for the supervision, training, and management of the food operati...
  • 4/23/2024 12:00:00 AM
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Lead Student Worker -- Chick Fil A - IUP Dining
  • Aramark Corp.
  • Indiana, PA
  • Job Description The Lead Student Worker is responsible for the supervision, training, and management of the food operati...
  • 4/23/2024 12:00:00 AM
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Pershing X, Director, Client Implementations
  • Pershing Limited
  • Indiana, PA
  • Bring your ideas. Make history.BNY Mellon offers an exciting array of future-forward careers at the intersection of busi...
  • 4/23/2024 12:00:00 AM
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Associate Director, Technical Product Mgmt (Based in India)
  • Lighthouse Document Technologies Inc.
  • Indiana, PA
  • Associate Director, Technical Product Mgmt (Based in India) Full Time Int'l - N/A Nagar, Bengaluru, Karnataka, INWhat is...
  • 4/23/2024 12:00:00 AM
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Associate Director-QC Micro
  • Eli Lilly And Company
  • Indiana, PA
  • Associate Director-QC Micro page is loaded Associate Director-QC Micro Apply locations US, Indianapolis IN time type Ful...
  • 4/23/2024 12:00:00 AM
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Executive Director Hospice - RN
  • LHC New
  • Johnstown, PA
  • Summary We are hiring for an Executive Director - RN, with Hospice experience. At Conemaugh Hospice in Johnstown, PA, a ...
  • 4/22/2024 12:00:00 AM
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About Johnstown, Pennsylvania

Johnstown is a city in Cambria County, Pennsylvania, United States, 43 miles (69 km) west-southwest of Altoona and 67 miles (108 km) east of Pittsburgh. The population was 20,978 at the 2010 census and estimated to be 20,402 in 2013. It is the principal city of the Johnstown, Pennsylvania, Metropolitan Statistical Area, which includes Cambria County. Johnstown is located in southwestern Cambria County at 40°19′31″N 78°55′15″W / 40.32528°N 78.92083°W / 40.32528; -78.92083 (40.325174, -78.920954). According to the United States Census Bureau, the city has a total area of 6.1 square miles (15....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$114,033 to $154,196
Johnstown, Pennsylvania area prices
were up 1.5% from a year ago
View detail

What does a Utilization Management Director do?

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