Utilization Management Director jobs in Saint Petersburg, 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

R
Director, Risk Management
  • Raymond James Financial, Inc.
  • Saint Petersburg, FL FULL_TIME
  • Director, Risk Management-2401329

    Description

    Job Summary:

    Under limited direction, uses extensive knowledge and skills obtained through education and experience to set the strategic direction of assigned risk discipline(s), translate business strategy into comprehensive risk assessment programs and manages the work of other staff in conducting reviews and developing risk profiles in a variety of functional areas. Oversees staff who lead large or multiple projects with significant scope and impact. Manages others in performing difficult assignments that are broad in nature requiring originality and ingenuity with appreciable latitude for unreviewed actions or decisions. Provides comprehensive solutions to escalated complex problems. Results are evaluated at agreed upon milestones for effectiveness in achieving specified results. Extensive contact with executive management and is required to lead others in identifying, researching, analyzing and resolving complex issues.

    Essential Duties and Responsibilities:

    • Sets the strategic direction for assigned risk discipline at the firm.
    • Represents assigned risk discipline’s program to management, regulators, and the Board of Directors.
    • Influences positive change through leadership, sound analysis, and demonstrated subject matter expertise.
    • Leads the team and collaborates extensively with peer risk areas to ensure a cohesive approach.
    • Directs risk and control consulting activities for assigned areas of responsibility, across multiple business areas, in accordance with internal standards, relevant government statutes and regulations.
    • Oversees multiple engagements concurrently from planning through reporting and produces quality deliverables in accordance with both department and professional standards.
    • Applies comprehensive expertise in one or more of the firm's businesses and leverages this knowledge into a leadership role in one or more teams.
    • Directly manages Managers and staff and performs human resource management activities, including identifying performance problems and approving recommendations for remedial action; evaluating performance; and interviewing and selecting staff.
    • Attracts, develops, and retains talent within the Risk Management organization and the Firm.
    • Maintains strong relationships with senior leaders, including executive management, and related control groups.
    • Uses excellent communication skills in order to influence a wide range of internal audiences including respective product, function, and executive management partners.
    • Ensures the use of sound judgment to provide an overall opinion on the business unit’s control environment and communicates findings to management. Challenges the team to identify opportunities for improvement in the design and effectiveness of key controls and mitigation strategies.
    • Holds entire team accountable for meeting deliverables, adhering to internal criteria and utilizing consistent methodology.
    • Ensures consistency of standards, appropriate level of rigor, and timeliness of risk management activities.
    • Oversees continuous monitoring for assigned areas, including monitoring of key metrics to identify control issues and adverse trends.
    • Evaluates existing governance programs for effectiveness and for consistency with regulatory expectations and industry leading practices.
    • Possesses strong project management and interpersonal skills, makes sound decisions, exhibiting initiative and intuitive thinking. Consulted often by others for advice and opinions and recognized as a leadership role model.
    • Participates in complex business initiatives and pro-actively advises and assists the business on change initiatives.
    • Viewed as an expert in evolving industry and regulatory changes impacting the business.
    • Builds and maintains effective working relationships with Regulators and External Auditors.
    • Manages expenses to budget, solving for department inefficiencies and excess spending.
    • Performs other duties and responsibilities as assigned.

    Qualifications

    Knowledge, Skills, and Abilities:

    Knowledge of:

    • In-depth understanding of risk management practices and methodologies, including risk assessment and a solid understanding of internal control and mitigation strategy concepts.
    • Specific subject matter expertise regarding control disciplines and an advanced understanding of Raymond James products and services, especially those associated with the area of responsibility.
    • Advanced investment concepts, practices and procedures used in the securities industry.
    • Principles of banking and finance and securities industry operations.
    • Financial markets and products.

    Skill in:

    • Implementing advanced risk theories and concepts.
    • Critical thinking, problem solving, and creativity.
    • Managing direct reports including managers and staff.
    • Demonstrated ability and success in interacting with and influencing senior leadership, including executive management.
    • Experience in managing against deadlines associated with an annual project plan.
    • Strong analytical skills particularly with regard to assessing the probability and impact of a control weakness.
    • Excellent verbal and written communication skills, with the ability to present complex and sensitive issues to management in a persuasive manner.
    • Enthusiastic, self-motivated, effective under pressure and willing to take personal risk and accountability.
    • Proven ability to multitask as well as assess and change priorities.
    • Ability to work well individually, and in teams, share information, support colleagues and encourage participation.

    Ability to:

    • Explain complicated topics/risk concerns to any audience.
    • Influence and guide across departmental boundaries.
    • Interpret, analyze, and apply technical information.
    • Perform human resource management activities.
    • Plan, assign, monitor, review, evaluate and lead the work of others.
    • Coach and mentor others.
    • Identify training needs and develop subordinates.
    • Balance conflicting resource and priority demands.
    • Facilitate meetings, ensuring that all viewpoints, ideas and problems are addressed.
    • Incorporate needs, wants and goals from different business unit perspectives into risk management engagements and recommendations.
    • Attend to detail while maintaining a big picture orientation.
    • Gather information, identify linkages and trends and apply findings to assignments.
    • Communicate effectively, both orally and in writing.
    • Read, interpret and apply information from business periodicals and professional journals.
    • Lead others in providing a high level of customer service.
    • Establish and maintain effective working relationships at all levels of the organization.

    Educational/Previous Experience Requirements:

    • Bachelor’s Degree and a minimum of ten (10) years experience in a related field, including at least four (4) years of people management experience.
    ~or~
    • Any equivalent combination of experience, education, and/or training approved by Human Resources.

    Licenses/Certifications:

    • CPA, CFE, CRMA, CIA, CBCP, CISSP, CRISC, Series 7 preferred.

    Raymond James Guiding Behaviors
    At Raymond James our associates use five guiding behaviors (Develop, Collaborate, Decide, Deliver, Improve) to deliver on the firm's core values of client-first, integrity, independence and a conservative, long-term view.

    We expect our associates at all levels to:
    • Grow professionally and inspire others to do the same
    • Work with and through others to achieve desired outcomes
    • Make prompt, pragmatic choices and act with the client in mind
    • Take ownership and hold themselves and others accountable for delivering results that matter
    • Contribute to the continuous evolution of the firm
    At Raymond James – as part of our people-first culture, we honor, value, and respect the uniqueness, experiences, and backgrounds of all of our Associates. When associates bring their best authentic selves, our organization, clients, and communities thrive. The Company is an equal opportunity employer and makes all employment decisions on the basis of merit and business needs.
    Job Auditing
    Primary Location US-FL-St. Petersburg-Saint Petersburg
    Organization RJF Risk Management
    Schedule Full-time
    Shift Day Job
    Travel Yes, 10 % of the Time

    Eligible for Discretionary Bonus Yes
    Thank You
  • 5 Days Ago
Apply this Job
R
Director, Wealth Management Technology
  • Raymond James Financial, Inc.
  • Saint Petersburg, FL FULL_TIME
  • Director, Wealth Management Technology-2400819 Description This position will follow our hybrid work model; we expect the selected candidate to work 2-3 days a week at our St. Petersburg, FL, corporat...
  • 1 Month Ago
Apply this Job
H
Director of Facility Management
  • HCA Florida St. Petersburg Hospital
  • Saint Petersburg, FL FULL_TIME
  • This position is incentive eligible. Introduction Do you want to join an organization that invests in you as a(an) Director of Facility Managment? At HCA Florida St. Petersburg Hospital, you come firs...
  • 1 Month Ago
Apply this Job
L
Community Director
  • LURIN Management Services LLC
  • ST. PETERSBURG, 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...
  • 5 Days Ago
Apply this Job
L
Community Director
  • LURIN Management Services LLC
  • Saint Petersburg, 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...
  • 24 Days Ago
Apply this Job
L
Assistant Community Director
  • LURIN Management Services LLC
  • Saint Petersburg, 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...
  • 11 Days Ago
Apply this Job
View All Utilization Management Director Jobs
Salary Company Skills How To Become Job Openings
Filters

Clear All
  • Filter Jobs by companies
  • More
Salary Company Skills How To Become Job Openings

0 Utilization Management Director jobs found in Saint Petersburg, FL area

C
HR Data Product Management Director (Hybrid)
  • Citigroup
  • Tampa, FL
  • The HR Data Product Management Director is a strategic leader responsible for overseeing the development, management, an...
  • 4/23/2024 12:00:00 AM
Apply this job
A
Transportation Program Management Director
  • Aecom
  • Tampa, FL
  • Company DescriptionWork with Us. Change the World.At AECOM, we're delivering a better world. Whether improving your comm...
  • 4/22/2024 12:00:00 AM
Apply this job
C
HR Data Product Management Director (Hybrid)
  • Citigroup
  • Tampa, FL
  • The HR Data Product Management Director is a strategic leader responsible for overseeing the development, management, an...
  • 4/22/2024 12:00:00 AM
Apply this job
H
HR Data Product Management Director (Hybrid)
  • Hispanic Technology Executive Council
  • Tampa, FL
  • The HR Data Product Management Director is a strategic leader responsible for overseeing the development, management, an...
  • 4/22/2024 12:00:00 AM
Apply this job
T
Tax Professionals - Senior, Supervisor, Manager, Director and Partner level - REMOTE / Great Work-life balance and progression!
  • Taurus Search
  • Tampa, FL
  • Tax Professionals Wanted! 📊💼 Are you a Tax Professional looking for a career that combines expertise with flexibility?...
  • 4/22/2024 12:00:00 AM
Apply this job
T
Tax Professionals - Senior, Supervisor, Manager, Director and Partner level - REMOTE / Great Work-li
  • Taurus Search
  • Tampa, FL
  • Tax Professionals Wanted! ???? Are you a Tax Professional looking for a career that combines expertise with flexibility?...
  • 4/21/2024 12:00:00 AM
Apply this job
A
Assistant Nurse Manager Weekend Only Worker Med Surg Medical Nights
  • AdventHealth
  • Riverview, FL
  • **All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid Days Off from Day One + ...
  • 4/19/2024 12:00:00 AM
Apply this job
Y
A Youth Development Program Director Starkey Elementary
  • YMCA of the Suncoast
  • Clearwater, FL
  • Title: Youth Development Program Director - Starkey Elementary Reports to: Youth Development Program Management Director...
  • 4/19/2024 12:00:00 AM
Apply this job
View All Utilization Management Director Jobs

About Saint Petersburg, Florida

St. Petersburg is a city in Pinellas County, Florida, United States. As of the 2015 census estimate, the population was 257,083, making it the fifth-most populous city in Florida and the largest in the state that is not a county seat (the city of Clearwater is the seat of Pinellas County). St. Petersburg is the second-largest city in the Tampa Bay Area, after Tampa. Together with Clearwater, these cities comprise the Tampa–St. Petersburg–Clearwater Metropolitan Statistical Area, the second-largest in Florida with a population of around 2.8 million. St. Petersburg is located on the Pinellas pen...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$119,982 to $162,240
Saint Petersburg, Florida area prices
were up 1.1% from a year ago
View detail

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