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)
Join Our Team at OCD Anxiety Centers:
At OCD Anxiety Centers, we are passionate about making a difference in the lives of those struggling with anxiety disorders. Through evidence-based practices and continuous learning, we strive to provide the highest quality care to clients and their families. If you're seeking a rewarding career where you can grow both personally and professionally, we invite you to be a part of our team.
What We Offer:
Competitive Compensation: Earn a wage starting at $18 per hour along with a comprehensive benefits package including medical/dental/vision coverage, 401k match, and more.
Positive Work Environment: Join a team that values integrity, accountability, teamwork, and innovation. We celebrate diversity and strive for excellence in everything we do.
Our Investment in You:
The Purpose of Your Role:
The UM specialist is an advocate who works with clients and commercial insurance payors to obtain approval for proper treatment services. They promote quality, cost-effective care strategies to payers using evidence-based criteria to meet the care guidelines. They are the companys connection between health care providers, clients, and insurance companies. After the provider determines the appropriate level of care during the intake, the UM specialist works with the client through the full approval cycle to help the payor identify medical necessity, appropriateness, and reasonableness of services recommended by the provider. They have a thorough knowledge of payer policies, guidelines, appeals, corrected/voided claim submission, and stay updated on all-payer changes.
The UM specialist demonstrates excellent customer service skills and communicates professionally and effectively. The UM specialist required effective communication and coordination with the Director of Utilization Management, with fellow UM specialists, insurance companies, and treatment team to obtain the maximum benefit for our clients. The individual in this position has overall responsibility for utilization performance improvement, denied authorizations, and operational management of OCD Anxiety Centers Utilization Management Department. The position entails coordinating and managing concurrent and retrospective reviews of all clients medical records over the continuum of care. The UM specialist is responsible for completing admission, concurrent and peer reviews as well as initiating denials and appeals. The UM specialist ensures cases are reviewed and responded to in a timely and clinically sound manner in accordance with policies and procedures.
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Equal Employment Opportunity Commission (EEOC) statement
OCD Anxiety Centers is committed to providing equal opportunity for all employees and applicants without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, genetics, disability, political affiliation, personal appearance, family responsibilities, or any other legally protected class under federal, state, or local law.
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