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)
Sentara Healthcare is seeking to hire a qualified individual to join our team as a Director, Utilization Management.
Position Status: Full-time, Day Shift
Position Location: This position is remote within our remote states.
Standard Working Hours: 8:00AM to 5:00PM (ET).
Minimum Requirements:
Preferred Requirements:
Expectations for this Role:
Sentara Health Plans is seeking a Director, Utilization Management supporting and facilitates continuous efforts to improve organizational and clinical performance, ensuring quality of care meets or exceeds regulatory standards and requirements as measured by division quality leaders.
Additional Expectations:
This role will have 4 direct managers and managers will have 2 team coordinators under them.
Sentara Health Overview
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).
Mission, Purpose, and Values
Sentara Healthcare Commitments
Sentara has made a commitment to its colleagues, patients, and members to:
Sentara Benefits
As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!
Please Note: Yearly Flu Vaccination are required for employment.
#indeed, #LI-AB1
For applicants within Washington State, the following hiring range will be applied: $116,407.20 - $147,267.12.
Candidates must have residency in one of the following states to work remotely in this position:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming
Key words: Clinical Pharmacy, PBM, Director Pharmacy PBM, remote, managed care
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