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)
Description
THE ROLE
The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus on Utilization Management and Denials principles such as performance improvement, healthcare finance (including contractual arrangements, utilization/quality metrics, and evidence of enhancing revenue cycle), regulatory standards, utilization management, industry benchmarks, demonstrated regulatory requirement experience and medical necessity criteria. The role requires the ability to consistently lead, support, and coach UM/UR staff and leaders. The position requires excellent interpersonal skills to collaborate with the physician community as well as other interdisciplinary groups. The role serves as a leader to create improvements in the quality and cost effectives of healthcare delivery.
Responsible to provide oversight and comprehensive strategic alignment, design, optimization, and improvement of the function. Direct responsibility and oversight for divisional pre-service and post-service utilization review, clinical claims audit, clinical appeals and reconsiderations, medical policy, and program management. Responsible for meeting Federal and applicable State regulatory requirements and quality accreditation standards while managing risks and complaints related to areas of responsibility. Is responsible for leading change acceleration processes for new program and project implementation efforts that span the division and the larger Providence Swedish delivery system. Sets direction and is focused on delivering quality improvement and expense management strategies through collaboration with other leaders to support the mission and strategic goals.
ESSENTIAL FUNCTIONS
QUALIFICATIONS
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
Providence has been serving the Pacific Northwest since 1856 when Mother Joseph and four other Sisters of Providence arrived in Vancouver, Washington Territory. Today, Providence is the largest health care provider in Washington located in communities large and small across the state. In western Washington, Providence provides care throughout the greater Puget Sound from Snohomish County to Lewis County.
Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requsition ID: 254430
Company: Providence Jobs
Job Category: Health Information Management
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 3002 ADMINISTRATION WA PRMCE
Address: WA Seattle 1730 Minor Ave
Work Location: Swedish Metropolitan Park East-Seattle
Pay Range: $67.28 - $108.30
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
Clear All
0 Utilization Management Director jobs found in Seattle, WA area