Utilization Management Director jobs in Pensacola, 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)
Recently Added Utilization Management Director jobs
Registered Nurse, Utilization Management
- Aspire Medical Staffing
-
Pensacola, FL
FULL_TIME
- Company DescriptionAspire Medical Staffing is a clinician owned and operated medical staffing company founded in 2011, contracting with Commercial and Federal medical agencies,facilities and schools. We believe in a collaborative effort with all patient care. Our medical teams always consist of support from team leaders and an efficient way to communicate and collaborate with everyone. Join Aspire Medical Staffing today to help service our Military and their families across the nation.Job DescriptionAspire Medical Staffing is looking for a Registered Nurse Utilization management to provide services at the Naval Hospital Pensacola, FLAssist in the design and implementation of activities to increase hospital staff involvement in and support of an active and coordinated Medical Management program. As a member of the Medical Management team, the HCW shall work in coordination with Case Management, Disease Management, Referral Management and other members of the healthcare team in order to assure the seamless delivery of care. All services shall be provided in accordance with Military Treatment Facility (MTF) policies and protocols.Incorporate utilization review activities using the generally accepted standards and criteria for determining medical necessity, appropriateness, and reasonableness when reviewing the quality, completeness, and adequacy of health care provided to individual patients and patient populations and subsequently with similar patient populations.Possess a valid driver’s license and a personal vehicle for use under the task order.Possess current certification in one (1) of the following: * Certified Professional Utilization Review (CPUR) from McKesson Health Solutions.Certified Professional Utilization Management (CPUM) from McKesson Health Solutions.Health Care Quality and Management Certification from American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)Certified Professional in Healthcare Quality (CPHQ) from Healthcare Quality Certification Board (HQCB).Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.Advanced Certification in Continuity of Care (ACCC) issued by the National Board for Certification in Continuity of Care.Nurse Case Manager (RN-NCM) issued by the American Nurses Credentialing Center.Care Manager Certified (CMC) issued by the National Academy of Certified Care Managers.ORPossess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.ANDGraduation from an accredited nursing educational program.Possess and maintain a current unrestricted license to practice as an RN in any one of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.QualificationsPossess current certification in one (1) of the following: * Certified Professional Utilization Review (CPUR) from McKesson Health Solutions.Certified Professional Utilization Management (CPUM) from McKesson Health Solutions.Health Care Quality and Management Certification from American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)Certified Professional in Healthcare Quality (CPHQ) from Healthcare Quality Certification Board (HQCB).Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.Advanced Certification in Continuity of Care (ACCC) issued by the National Board for Certification in Continuity of Care.Nurse Case Manager (RN-NCM) issued by the American Nurses Credentialing Center.Care Manager Certified (CMC) issued by the National Academy of Certified Care Managers.ORPossess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.ANDGraduation from an accredited nursing educational program.Possess and maintain a current unrestricted license to practice as an RN in any one of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.Additional InformationTo discuss rates and caseloads- APPLY TODAY! Submit your resume today or call Amanda Perez 210-426-0268 for more information. I look forward to hearing from you soon. www.aspiremedicalstaffing.com
- 1 Month Ago
Director - Risk Management
- Baptist Health Care
-
Pensacola, FL
FULL_TIME
- Job DescriptionThe Director - Risk Management develops, coordinates, and administers facility-wide systems for risk identification, incident investigation, error reduction/prevention, and occurrence r...
- 1 Month Ago
Community Director
- LURIN Management Services LLC
-
PENSACOLA, FL
FULL_TIME
- DescriptionPosition SummaryThe Community Director is responsible for the successful day-to-day financial, administrative, sales, marketing, and maintenance operations of the community while ensuring c...
- 1 Month Ago
Director of Surgical Services
- Mountain Management Group
-
Pensacola, FL
FULL_TIME
- This Director will report to the Chief Nursing Officer and will act as a liaison between the Hospital Administration and the staff. The Director is a professional nurse, responsible for directing and ...
- 21 Days Ago
Assistant Community Director
- LURIN Management Services LLC
-
PENSACOLA, FL
FULL_TIME
- DescriptionPosition SummaryThe Assistant Community Director is responsible for assisting the Community Director in managing all operational and financial aspects of the property to ensure company goal...
- Just Posted
RN Director of Operating Room
- Clinical Management Consultants
-
Bonifay, FL
FULL_TIME
- A stellar community hospital in sunny Florida is looking to hire a RN Director of Operating Room to be an influential change agent in an active service line. This is an exceptional opportunity for a s...
- 11 Days Ago
Filters
- Current Active Filter
- Pensacola, FL
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Utilization Management Director jobs found in Pensacola, FL area
General Manager
- Domino's Franchise
-
Pensacola, FL
- Job Description Job Description Company DescriptionTwomays Inc and Teamdriven Inc operate as one Franchise within Domino...
- 4/24/2024 12:00:00 AM
Area Business Director, Denver
- Sanofi Group
-
Pensacola, FL
- Travel: Ability to travel up to 75% of the time to coach Area Business Managers, see customers, and attend conventions, ...
- 4/24/2024 12:00:00 AM
Manager Mission Assurance 2
- Northrop Grumman
-
Pensacola, FL
- Northrop Grumman Manager Mission Assurance 2 Salt Lake City , Utah Apply Now At Northrop Grumman, our employees have inc...
- 4/24/2024 12:00:00 AM
Metals Department Manager - Eurofins TestAmerica - Pensacola, FL
- Viracor Eurofins
-
Pensacola, FL
- **Metals Department Manager - Eurofins TestAmerica - Pensacola, FL** * Pensacola, FL, USA * Full-time **Company Descript...
- 4/24/2024 12:00:00 AM
Community Director
- Occupancy Heroes, Inc.
-
Pensacola, FL
- Job Description Job Description Are you looking for a great position in the Multifamily industry??? We are currently see...
- 4/24/2024 12:00:00 AM
Programs Manager - Community Land Trust (CLT)
- Pensacola Habitat for Humanity
-
Pensacola, FL
- Job Description Job Description Job Title: Programs Manager - Community Land Trust (CLT) Department: Asset Management Su...
- 4/24/2024 12:00:00 AM
Abercrombie & Fitch - Manager in Training, Destin Commons
- Abercrombie and Fitch Co.
-
Fort Walton Beach, FL
- Company Description Abercrombie & Fitch Co. (NYSE: ANF) is a leading, global specialty retailer of apparel and accessori...
- 4/23/2024 12:00:00 AM
Area Business Director, Phoenix
- Sanofi Group
-
Pensacola, FL
- Travel: Ability to travel up to 75% of the time to coach Area Business Managers, see customers, and attend conventions, ...
- 4/23/2024 12:00:00 AM
About Pensacola, Florida
Pensacola (/ˌpɛnsəˈkoʊlə/) is the westernmost city in the Florida Panhandle, approximately 13 miles (21 km) from the border with Alabama, and the county seat of Escambia County, in the U.S. state of Florida. As of the 2010 census, the city had a total population of 51,923, down from 56,255 at the 2000 census. Pensacola is the principal city of the Pensacola metropolitan area, which had an estimated 461,227 residents in 2012.
Pensacola is a sea port on Pensacola Bay, which is protected by the barrier island of Santa Rosa and connects to the Gulf of Mexico. A large United States Naval Air Statio...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$114,666 to $155,052
Pensacola, Florida area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
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