Utilization Management Director jobs in Newark, NJ

Responsibilities

The Director Utilization and Case Management will be responsible for the strategic direction setting, management, continuous improvement, and maintenance of the Utilization and Case Management Services Unit. This role evaluates the efficiency, appropriateness, necessity of the use of medical services, procedures, and level of care for patients. This position is empowered to review medical services with evidenced-based criteria that will be reviewed by payers. Develops and implements strategies to improve workflows and processes/procedures to enhance the utilization review program. Works to ensure care is delivered to patients at University Hospital in appropriate time frames to maximize patient flow and reimbursement. Ensures that discharge planning is thorough, patient-centered, and effective by fostering the concept of evidence-based practice and employing strategic interventions that assures that the care meets national, regional and University Hospital quality improvement standards. Provides decision support to patients, families, and physicians managing patient and family expectations. Supports the mission of University Hospital.

Qualifications

Licensed as a Registered Nurse in the State of New Jersey. Bachelor’s Degree in Nursing required. Five (5) years of experience in an acute care setting, which must include at least two (2) years of experience in utilization review/case management/quality improvement leadership position required. Master’s Degree is preferred. Excellent interpersonal, communication skills. Must demonstrate a strong orientation to customer satisfaction, effective teamwork, problem solving and utilize small group dynamics in conflict management. Computer literacy required. Must possess leadership and management ability.