Utilization Management Director jobs in Melbourne, FL

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)

C
Utilization Data Management Specialist
  • Community Based Care of Brevard, Inc.
  • Rockledge, FL FULL_TIME
  • Annual Salary: $45,000/year

    Position Summary: The Utilization Data Management Specialist will report to the Utilization Management Program Manager. The position will ensure data analysis within the Mindshare Technologies Platform and will support data sharing across the System of Care. This position requires advanced data management skills with experience using multiple platforms and functions. Primary responsibility will be utilizing the Prevention Services and Activity Management (PSAM) System. This position will be an apprentice and backup for all functions of the Director of UM. As such, it will be expected that this person becomes familiar with providing access to (FSFN, PSAM, TACF, BECA, FPL, FMMIS) and all related forms necessary to grant access and deactivate users. The position will be responsible for learning the Children’s Mental Health funding process (100/806). This role may also provide support in the agencies’ efforts in performance related data; extracting and producing data sets from the FSFN reporting environment. The Utilization Data Management Specialist will serve as the Data Security Officer in the absence of the Utilization Management Program Manager.

    Technical/Functional Expectations:

    1. Application Implementation – Essential Function: Coordinate activities; analyze impact on current processing schedules and service levels in order to implement new applications (PSAM Modernization).
    2. Data Analysis: Essential Function: Complete hypothesis, normal distribution, and process capability analysis tests in order to analyze data.
    3. Reports Preparation – Essential Function: Collect, analyze, and summarize data within the Utilization Management System in order to prepare reports for users and other stakeholders.
    4. Organizes, Aggregates and Compiles Data in Report Formats: This position organizes aggregates and compiles data for regularly scheduled forums such as the agency Provider Network Meeting and Board Meeting as required.
    5. FSFN/SACWIS Support: The position may provide support to the agencies performance. As such, intermediate skills in FSFN reporting is required.  This may require generating data reports as this correlates to agency contract measures and scorecard performance.
    6. Serves as Data Security Officer: This position will serve as the agency’s backup Data Security Officer; responsible for management of new users in multiple data bases in accordance with agency security agreements and protocols.
    7. Extracts and Produces Data Sets from Multiple Sources: This position is responsible for extracting and producing data sets from multiple data bases; (such as Mindshare PSAM and TACF) performing data analysis as needed to identify trends and monitor, track and report outcomes.
    8. Organizes, Aggregates and Compiles Data in Report Formats: This position organizes aggregates and compiles data for regularly scheduled forums such as the agency Operations Meeting and Board Meeting.
    9. Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes.

    Behavioral Competencies:

    1. Decisiveness: Able to use available information to draw a timely conclusion and take quick action; make timely decisions in stressful situations; make quick, timely decisions when necessary.
    2. Integrity: Able to demonstrate consistency of words and actions; do what is right even when no one is watching; demonstrates sound business ethics; protect both company and public interests.
    3. Influence: Able to positively change opinions and actions of others in a desired direction; present information in a persuasive manner; clarify information in order to gain understanding and buy-in.
    4. Develop Relationships: Able to relate to others, building credibility and rapport; relate to others in an honest and straightforward manner; build one-on-one relationships that incorporate cooperation, trust, and respect.
    5. Decision Making: Able to make objective decisions when dealing with emotional or controversial topics; identify and choose between multiple options; understand consequences of potential decisions.
    6. Planning and Organizing: Able to improve efficiency through planning and organizing; identify specific action steps and plans; anticipate problems and develop contingency plans.
    7. Sensitivity: Work effectively with and show sensitivity to cultural differences and various socio-economic backgrounds of others.
    8. Ethics: Adhere to and model principles and values of Agency and System of Care by being strength-based, solution-focused, maintains highest level of integrity and ethical standards and work collaboratively with employees, partners, stakeholders and clients in all interactions.

    Business Experience:

    1. 2-3 years’ experience in UM Systems preferred: This is required in order to ensure that services provided are meeting outcomes identified.
    2. 2-3 years data management experience: This is required in order to compile data and create reports regarding patterns and trends.
    3. Solution-focused, Collaborative Communication Skills: This is required in order to communicate with various internal and external stakeholders at various levels.
    4. Excellent Analytical and Problem Solving Skills: This is required in order to provide accurate information and to identify and correct discrepancies.
    5. Excellent Organization and Attention to Detail Skills: This is required in order to manage multiple priorities while maintaining data integrity of several sources.
    6. Valid Driver's License - Essential: This is required in order to travel throughout the county and to multiple sites.

    Educational and Experience Requirements:

    1. BA/BS - Bachelor’s Degree or equivalent required.
    2. 2-3 years Navigating and Reporting Using Supplementary data platforms.
    3. Child Welfare Experience preferred.

    Physical Requirements:

    1. Reading
    2. Writing
    3. Listening
    4. Speaking
    5. Sitting
    6. Standing
    7. Typing

    Brevard Family Partnership family of agencies are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status. These employers also maintain Drug-Free Workplaces. Requests for Auxiliary Aids for Hearing Impaired or Limited English Proficiency Candidates may be made with a minimum of five (5) days notice to C. Hernandez at (321) 752-4650.

  • 1 Month Ago

N
Regional Director of Account Management
  • Nextech
  • Melbourne, FL FULL_TIME
  • Overview Overview: We are proud to be America’s Largest Independent Self-Performing HVAC/R Service Provider. Over the past 30 years, our continued focus on Quality, Value, and Integrity has enabled us...
  • 1 Month Ago

C
Director Care Management
  • Cleveland Clinic
  • Vero Beach, FL FULL_TIME
  • Join our team at Cleveland Clinic Indian River Hospital, and experience world-class healthcare at its best. Cleveland Clinic Indian River has been recognized as one of the top regional hospitals in So...
  • 1 Month Ago

C
Community Director
  • Concord Management Ltd.
  • Rockledge, FL FULL_TIME
  • ConcordRENTS is a distinguished leader in providing a quality and customer-centric property management experience with a focus on affordable and market rate multifamily communities throughout Florida....
  • 20 Days Ago

C
Lifestyle Director
  • Campbell Property Management
  • Port Saint Lucie, FL FULL_TIME
  • The person filling this position serves as the manager of resident programs and annual events that include recreational, social, health & wellness, cultural, travel, and entertainment, etc. The Direct...
  • Just Posted

C
Surgical Services Nurse Director
  • Clinical Management Consultants
  • Vero Beach, FL FULL_TIME
  • A leading healthcare organization, located on the treasure coast of Florida, is looking for an experienced Director of Surgical Services to join their dynamic team! This 350 bed, acute-care hospital h...
  • 21 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Utilization Management Director jobs found in Melbourne, FL area

P
Clinical Coordinator
  • Parrish Healthcare
  • Titusville, FL
  • Department: Medical Surgical Schedule/Status: 7:00pm-3:30am; Full Time Standard Hours/Week: 40 GENERAL DESCRIPTION Under...
  • 4/25/2024 12:00:00 AM

B
Project Manager - Property Condition Assessments
  • Blew & Associates, P.A.
  • Orlando, FL
  • Blew & Associates, P.A. is seeking an experienced Project Manager of Property Condition Assessments to join our team. Th...
  • 4/25/2024 12:00:00 AM

H
RN Registered Nurse PCU FT Days $15,000 Bonus $3,000 Relo
  • Hiring Now!
  • Indialantic, FL
  • Registered Nurse PCU AdventHealth New Smyrna Beach Location Address: 401 Palmetto St. New Smyrna, FL 32168 Top Reasons T...
  • 4/25/2024 12:00:00 AM

H
RN Registered Nurse PCU FT Days $15,000 Bonus $3,000 Relo
  • Hiring Now!
  • Palm Bay, FL
  • Registered Nurse PCU AdventHealth New Smyrna Beach Location Address: 401 Palmetto St. New Smyrna, FL 32168 Top Reasons T...
  • 4/25/2024 12:00:00 AM

H
RN Registered Nurse PCU FT Days $15,000 Bonus $3,000 Relo
  • Hiring Now!
  • Melbourne Beach, FL
  • Registered Nurse PCU AdventHealth New Smyrna Beach Location Address: 401 Palmetto St. New Smyrna, FL 32168 Top Reasons T...
  • 4/25/2024 12:00:00 AM

S
Managing Director of Custom Solutions
  • ssur
  • Orlando, FL
  • Together with commercial leadership, the Managing Director of Custom Solutions will develop and implement strategies for...
  • 4/22/2024 12:00:00 AM

C
Managing Director/Market Leader - Orlando
  • Colliers
  • Orlando, FL
  • Make your next move an expert one. At Colliers it's not our success that sets us apart, it's how we achieve it. Our peop...
  • 4/22/2024 12:00:00 AM

H
Clinical Coordinator
  • Hiring Now!
  • Titusville, FL
  • Department: Medical Surgical Schedule/Status: 7:00pm-3:30am; Full Time Standard Hours/Week: 40 GENERAL DESCRIPTION Under...
  • 4/22/2024 12:00:00 AM

Melbourne /ˈmɛlbərn/ is a city in Brevard County, Florida, United States. As of the 2010 census, the population was 76,068. The municipality is the second-largest in the county by both size and population. Melbourne is a principal city of the Palm Bay – Melbourne – Titusville, Florida Metropolitan Statistical Area. In 1969 the city was expanded by merging with nearby Eau Gallie. Melbourne is located approximately 60 miles (97 km) southeast of Orlando on the Space Coast, along Interstate 95. It is approximately midway between Jacksonville and Miami. According to the United States Census Bureau,...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$115,552 to $156,250
Melbourne, Florida area prices
were up 1.5% 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