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)
Responsible for providing the overall leadership, management & direction of Case Management operations and staff, and for producing successful outcomes and results. Directs and implements case management programs, including utilization review, intake and discharge planning, and managed care contracting and negotiation. Manages the integration of social services/case management functions into the patient care, discharge, and home planning processes in coordination with other hospital departments, external service organizations, agencies and healthcare facilities. Utilizes advanced strategies and tactics to provide the highest level of service.
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