Utilization Management Director jobs in Schenectady, NY

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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Utilization Management RN
  • Ellis Medicine
  • Schenectady, NY FULL_TIME
  • Basic Function:
    The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, community or agency representatives for a positive patient outcome. The UM RN is responsible for preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures the appropriate level of care is determined and ensures accurate assessment of medical necessity; thus appropriate reimbursement.
     
    Requirements:
    Bachelor’s degree in Nursing or health care related field required. Current registration as a Licensed Registered Professional Nurse in New York State. Two (2) to three (3) years' experience in case management, discharge planning and/or progression of care in the acute-care setting. Understanding of New York State and Federal guidelines and insurance regulations. Minimum one (1) year Utilization Management experience preferred via, industry clinical standards; ie. InterQual, Milliman Care Guidelines. Leadership and management experience, strong communication and interpersonal skills with the ability to mentor others and work effectively and collaboratively with nursing colleagues, physicians and other healthcare professionals and administrators.
     
    Responsibilities:
     • Serves as a subject matter expert and leader in the ever-changing healthcare environment.
      • Exercise a leadership style that fosters teamwork and collaboration with all hospital staff, post-acute care facilities and providers.
      • Effectively communicates with the patient, family, physician and health care team to ensure understanding of appropriate management and insurance guidelines and regulations.
      • Determines appropriate level of care/status via clinical review within 24 hours of registration and/or placement.
      • Daily review of all observation patients via InterQual or Milliman Care Guidelines.
      • Collaborates with on-site insurance liaisons to determine appropriate reimbursement and appropriate status.
      • Escalates reviews timely to physician advisor timely for lack of medical necessity and/or status discrepancies.
      • Identifies opportunities to reduce cost of managing patient care without compromising outcomes.
      • Issues denials to those that do not meet medical necessity criteria for hospital admission.
      • Reports all variances through established outcome management and quality improvement processes.
      • Identifies and tracks issues that contribute to status changes and denied hospital reimbursement.
      • Identifies avoidable days via Midas that contributes to increased length of stay.
      • Carries out work assignments within allotted time-frame.
      • Accurately documents utilization management activities per policy.
      • Communicates clearly with all members of patient, family healthcare team, and insurance liaisons.
      • Continually updates knowledge of nursing theory, insurance criteria, current healthcare trends and available community resources.
      • Responsible for yearly re-education on industry standard criteria;. InterQual/Milliman Care Guidelines.
      • Maintains integrity and confidentiality of all data.
     
     
  • 12 Days Ago

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Director of Quality Management
  • Four Winds Hospitals
  • Saratoga Springs, NY FULL_TIME
  • As a member of the Senior Leadership Team, the Director will work collaboratively with senior hospital staff, medical staff leadership and other stakeholders to ensure the highest levels of care, qual...
  • 2 Days Ago

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Director of 3rd Party Management
  • Prime Group Holdings
  • Saratoga Springs, NY FULL_TIME
  • Company Overview Prime Group Holdings, LLC, a vertically-integrated private equity real estate firm focused on self storage and other alternative real estate asset classes, has an exciting opportunity...
  • 3 Days Ago

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Director of Facilities Management
  • Vireo Health
  • Johnstown, NY FULL_TIME
  • Who we are:Here at Vireo Health, Inc. (“Vireo”) our mission is to bring the best of technology, science, and engineering to the cannabis industry. We are a physician-led, customer-focused team of more...
  • 12 Days Ago

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Real Estate Development Director, Upstate New York
  • Pennrose Management
  • Schenectady, NY FULL_TIME
  • Overview To best serve the communities in which it operates, Pennrose executes its development activities under a decentralized structure where state(s) are organized within “regions” led by Regional ...
  • 14 Days Ago

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Registered Nurse (RN) –Supportive Management
  • The W Management Group LLC
  • Scotia, NY FULL_TIME
  • Overview Registered Nurse (RN) - Supportive Management • Excellent Benefits • Flexible Scheduling • Team Environment Scotia Mansion of The W Group is seeking a Full Time Registered Nurse with expertis...
  • 15 Days Ago

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0 Utilization Management Director jobs found in Schenectady, NY area

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Laboratory Manager/Director
  • H2 Talent
  • Menands, NY
  • Our client, a cannabis testing lab, has a need for a Lab Manager/Director to join their team and oversee daily activitie...
  • 3/28/2024 12:00:00 AM

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Structural Project Manager
  • Johnson, Mirmiran, and Thompson Inc.
  • Albany, NY
  • Johnson, Mirmiran & Thompson is a dynamic, 100% employee-owned consulting firm of more than 2,000 professionals that pro...
  • 3/28/2024 12:00:00 AM

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Assistant Nurse Manager Emergency Department
  • Clinical Management Consultants
  • Albany, NY
  • An award-winning teaching hospital located in upstate New York is currently searching for an experienced Assistant Nurse...
  • 3/28/2024 12:00:00 AM

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On Call Resident Aide - Schenectady Booth Home
  • The Salvation Army - Empire State Division Headquarters
  • Schenectady, NY
  • Job Description Job Description SCOPE AND PURPOSE OF POSITION: The Evangeline Booth Miracle Home is an 18 bed shelter th...
  • 3/27/2024 12:00:00 AM

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CDL Driver Operator Class A or B
  • ACV Enviro Corp.
  • Albany, NY
  • **CDL Driver Operator Class A or B** > Albany, NY | Operations | Posted: Mar 29, 2021 **Summary** The primary purpose of...
  • 3/26/2024 12:00:00 AM

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Project Director - Government
  • Page Southerland Page, Inc.
  • Albany, NY
  • Overview: We are hiring a Project Director specific to our Government sector for our Albany, NY office. At Page, we prom...
  • 3/25/2024 12:00:00 AM

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Receptionist Full TIME VERY COMPETITIVE PAY & BENEFITS
  • Promenade at University Place
  • Albany, NY
  • Promenade at University Place - Summary: The Receptionist is often the initial contact and first impression of the commu...
  • 3/25/2024 12:00:00 AM

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Executive Director
  • 518 ElevatED
  • Albany, NY
  • Are you seeking an exceptional opportunity to contribute to a dynamic team, make a meaningful impact on the local commun...
  • 3/24/2024 12:00:00 AM

Schenectady (/skəˈnɛktədi/) is a city in Schenectady County, New York, United States, of which it is the county seat. As of the 2010 census, the city had a population of 66,135. The name "Schenectady" is derived from a Mohawk word, skahnéhtati, meaning "beyond the pines". Schenectady was founded on the south side of the Mohawk River by Dutch colonists in the 17th century, many from the Albany area. They were prohibited from the fur trade by the Albany monopoly, which kept its control after the English takeover in 1664. Residents of the new village developed farms on strip plots along the rive...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$127,847 to $172,872
Schenectady, New York 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