Utilization Management Director jobs in Salisbury, NC

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)

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IDD Utilization Management Supervisor (Hybrid Option)
  • Partners Health Management
  • Statesville, NC FULL_TIME
  • Competitive Compensation & Benefits Package!
    Position eligible for –
    • Annual incentive bonus plan
    • Medical, dental, and vision insurance with low deductible/low cost health plan
    • Generous vacation and sick time accrual
    • 12 paid holidays
    • State Retirement (pension plan)
    • 401(k) Plan with employer match
    • Company paid life and disability insurance
    • Wellness Programs
    See attachment for additional details.

    Office Location:
    Hybrid option; Available for any Partners' locations
    Projected Hiring Range: Depending on Experience
    Closing Date: Open Until Filled
    Work Hours: M-F, 8 a.m. - 5 p.m.


    Primary Purpose of Position:
    The primary purpose of this position is to supervise the IDD team which evaluates medical necessity, appropriateness and efficiency of the services requested for authorization against established criteria adopted by Partners Behavioral Healthcare Management.

    Role and Responsibilities:

    • To ensure IDD Utilization Management Reviewers respond to IDD requests for authorization from IDD Care
    • Managers and Providers with appropriate authorization decisions that are guided by Clinical Policy.
    • To ensure services are based on individual need and standardized procedures.
    • To supervise the review and authorization of initial Plans of Care (POC), Continuing Need Review (CNR) and any revisions to the annual plan within expected turn-around –time.
    • Consulting with Care Managers/Providers/enrollees regarding authorization requests.
    • Monitor work flow and volume of work
    • Supervision of IDD Utilization Management Reviewers.
    • Provide training for IDD Utilization Management staff
    • Work with IDD Care Managers and Provider Network staff to provide Technical Assistance to providers
    • Participate in various departmental committees as assigned by the UM Director
    • Participate in Mediations and other Appeal Proceedings as a representative of the MCO
    • All other duties as assigned

    Knowledge, Skills and Abilities:

    • Extensive knowledge IDD diagnoses, treatment interventions and evidence-based practices for this disability and co-occurring behavioral and medical disorders
    • Knowledge of 1915(b)(C) waiver, Supports Intensity Scale, Clinical Policy and clinical guidelines as they relate to authorization of services
    • Awareness of cultural diversity as it applies to the treatment needs of major ethnic/racial groups served by the organization
    • Exceptional interpersonal and communication skills
    • Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
    • Problem solving, negotiation, arbitration, and conflict resolution skills
    • Detail-oriented, able to organize multiple tasks and priorities and to effectively manage projects from start to finish
    • Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships

    Education/Experience Required: A Degree in a Human Services field with clinical licensure and at least three (3) years of experience in I/DD services or a Registered Nurse with three (3) years of experience in I/DD services, including three (3) years Administrative Supervisory experience.

    Education/Experience Preferred: A Master’s Degree in a Human Services field with clinical licensure and at least three (3) years of experience in I/DD services or a Registered Nurse with three (3) years of experience in I/DD. Previous experience in Utilization Management.

    Licensure/Certification Requirements: Current unrestricted license with the appropriate professional board of licensure in the state of North Carolina. Licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing or Independent License in NC as a LCSW, LPC, LPA, LMFT. An Associate license does not meet the requirements. An employee may be dual licensed with one of the specialties listed here can also be licensed as an LCAS. NC DMA contract requirements does not allow for an LCAS to be a standalone license for working in UM.

    Employee is responsible for complying with respective licensure board’s continuing education/training requirements to maintain an active license.

  • 15 Days Ago

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IDD Utilization Management Supervisor (Hybrid Option)
  • Partners Health Management
  • Kannapolis, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 18 Days Ago

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IDD Utilization Management Supervisor (Hybrid Option)
  • Partners Health Management
  • Mocksville, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 18 Days Ago

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I/DD Utilization Management Reviewer QP (Hybrid Option)
  • Partners Health Management
  • Statesville, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 11 Days Ago

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I/DD Utilization Management Reviewer QP (Hybrid Option)
  • Partners Health Management
  • Mocksville, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 17 Days Ago

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I/DD Utilization Management Reviewer QP (Hybrid Option)
  • Partners Health Management
  • Kannapolis, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 17 Days Ago

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0 Utilization Management Director jobs found in Salisbury, NC area

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Category Management Director - Automotive Chemicals
  • Highline Warren
  • Charlotte, NC
  • Job Description Job Description The Category Director for Automotive will act as the entrepreneurial general manager res...
  • 3/18/2024 12:00:00 AM

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Director, Product Management Excellence
  • Trane Technologies
  • Davidson, NC
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solut...
  • 3/17/2024 12:00:00 AM

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Managing Director, Sales & Solutions - North American Utilities
  • CBRE
  • Charlotte, NC
  • Managing Director, Sales & Solutions - North American Utilities Job ID 126039 Posted 11-Aug-2023 Service line GWS Segmen...
  • 3/16/2024 12:00:00 AM

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Tax Professionals - Senior, Supervisor, Manager, Director and Partner level - REMOTE / Great Work-life balance and progression!
  • Taurus Search
  • Charlotte, NC
  • Tax Professionals Wanted! 📊💼 Are you a Tax Professional looking for a career that combines expertise with flexibility?...
  • 3/15/2024 12:00:00 AM

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Sr. Program Manager/Director- REMOTE
  • Per Sé Group
  • Charlotte, NC
  • Senior Program Manager/Director for a Direct Hire/Remote role; U.S.-based renewable energy company that owns and operate...
  • 3/15/2024 12:00:00 AM

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Sr. Program Manager/Director- REMOTE
  • Per S Group
  • Charlotte, NC
  • Senior Program Manager/Director for a Direct Hire/Remote role; U.S.-based renewable energy company that owns and operate...
  • 3/15/2024 12:00:00 AM

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Tax Professionals - Senior, Supervisor, Manager, Director and Partner level - REMOTE / Great Work-life balance and progression!
  • Taurus Search
  • Charlotte, NC
  • Tax Professionals Wanted! 📊💼 Are you a Tax Professional looking for a career that combines expertise with flexibility?...
  • 3/15/2024 12:00:00 AM

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External Audit Professionals - Senior, Supervisor, Manager, Director and Partner level - REMOTE / Great Work-life balance and progression!
  • Taurus Search
  • Charlotte, NC
  • Audit & Assurance Professionals Wanted! 📊💼 Are you an External Audit Professional looking for a career that combines e...
  • 3/14/2024 12:00:00 AM

Salisbury (/ˈsɔːlzbəri/ SAWLZ-bər-ee) is a city in the Piedmont of North Carolina; it is the county seat of Rowan County. Located 44 miles northeast of Charlotte and within its metropolitan area, the town has attracted a growing population. This was 33,663 in the 2010 Census (growing 27.8% from the Census in 2000). Founded in 1753, Salisbury is noted for its historic preservation, with five Local Historic Districts and ten National Register Historic Districts. Salisbury is the home to North Carolina soft drink, Cheerwine, regional supermarket, Food Lion and Rack Room Shoes. It is one of two ci...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$119,849 to $162,058
Salisbury, North Carolina area prices
were up 1.5% from a year ago

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