Utilization Management Director jobs in Spokane, WA
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
Utilization Management Coordinator I
- PacificSource
-
Spokane, WA
FULL_TIME
- Base Salary Range: $35,190.90 - $56,305.45 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. The Utilization Management (UM) Coordinator I is fundamental to the utilization management team and receives, researches, and coordinates initial and follow-up action related to clinical documentation and requests from a variety of sources. Adheres to rigorous regulatory requirements, builds team collaboration, contributes to team improvements, and creates enhanced member and provider partner relationships. Essential Responsibilities: High level - Adhere to dependability, member and provider focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all functions. Follow stringent guidelines to ensure all work meets PacificSource corporate standards for accuracy and compliance with federal, state, and national accreditation regulations. UM Process - Coordinate, create, and document UM cases in the electronic record by validating preauthorization requirements, utilizing a basic understanding of ICD, CPT and HCPCS codes, and including plan types, member benefits, eligibility, limitations, exclusions, and claims history. Assess accuracy of daily inpatient information from external systems and inpatient facilities, compile inpatient data, create inpatient events including diagnosis codes, and triage for review by UM and CM clinical staff. Collaborate with clinical staff by synchronizing information for utilization management, care management, prior authorization, inpatient stay, and retroactive claim reviews. Integrate medical records as required and document status of internal or external reviews in the medical record. Identify and promptly initiate corrective steps to resolve workflow issues. Administratively authorize services as directed by UM Leadership. Effectively manage an active telephonic queue by delivering excellent customer service to incoming caller and documenting HIPAA compliance. Provide information on prior authorization, referrals, inpatient admissions and stays, health-related information, determinations, claims review, and possess an understanding of when to forward members and providers to Appeals and Grievances. Manage difficult calls and escalate or triage calls to more experienced staff as necessary. Work between multiple systems, utilizing critical thinking and problem-solving skills while successfully keeping the member at the center. Identify and keep readily accessible all up-to-date reference documents, policies and procedures needed to be successful. People - Attend and contribute to cross-functional member-focused meetings, educate team members on UM functions, and assist members in getting the right care at the right time. Utilize knowledge, understanding and critical thinking to research difficult cases related to UM processes and requirements from members, providers, employer groups, agents, member representatives and internal customers. Serve as a liaison between members and providers regarding benefit utilization and requirements. Provide education and facilitate the member and provider understanding and experience of utilization processes, including benefit structure, contract parameters, and of the information necessary to effectively complete a prior authorization or inpatient stay. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of two years of experience in health insurance industry or medical setting required. One year experience working with CPT/HCPCS/ICD coding preferred. Other equivalent professional related experience may be considered. Education, Certificates, Licenses: High school diploma or equivalent required, associate degree, medical assistant certification, licensed professional nurse or certified professional coding certification preferred. Knowledge: Demonstrated basic knowledge and understanding of medical terminology, procedures, anatomy, diagnoses, care modalities, treatment plans, and medical coding. Basic understanding of insurance, and standard medical billing practices preferred. Proficient computer, and strong written and verbal communication skills. Strong organizational skills and experience with Microsoft Office programs, medical, and claims management software. The ability to work independently at times with minimal supervision. Competencies Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Group Problem Solving, Listening (active), Organizational skills/Planning and Organization, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our 1,900 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance April 17: Oregon State Spring Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) April 18: University of Oregon Spring Career Fair, 12p-4p at the EMU Ballroom (1395 University St, Eugene OR 97403) April 24: Linn Benton Community College Career Fair, 10a-2p (6500 Pacific Blvd SW, Albany OR 97321) May 14: Idaho Business League, 10a-2p at Courtyard by Marriot (1789 S Eagle Road, Meridian ID) PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2023 alone we had 407 internal promotions! Top Workplace 2024 USA | USA Today Certified Age Friendly Employer, 2023 | Age Friendly Institute Top Workplace 2023 and 2022 for Idaho | Idaho Press Top Workplace 2023 and 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HRrecruiting@PacificSource.com.
- 6 Days Ago
Utilization Management Coordinator I
- PacificSource
-
Spokane, WA
FULL_TIME
- Base Salary Range: $35,190.90 - $56,305.45 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal oppor...
- 6 Days Ago
Utilization Management - LPN (Remote)
- Morgan Stephens
-
Spokane, WA
FULL_TIME
- Job Summary: As a Utilization Management RN, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate ad...
- 7 Days Ago
UTILIZATION REVIEW/CASE MANAGEMENT REGISTERED NURSE
- Newport Hospital and Health Services
-
Newport, WA
OTHER
- Job Details Job Location: NHHS Hospital - Newport, WA Position Type: Full-Time/Part-Time Education Level: 2 Year Degree Salary Range: $38.04 - $68.08 Hourly Job Shift: Days Job Category: Health Care D...
- 1 Month Ago
Interim Nurse Director of Quality Management
- Clinical Management Consultants
-
Othello, WA
FULL_TIME
- If you are a Nurse Director of Quality Management who is looking for an exciting and challenging career with a reputable Medical Center in beautiful and serene Washington state, look no further! The h...
- 19 Days Ago
Nurse Director of Quality and Risk Management
- Clinical Management Consultants
-
Othello, WA
FULL_TIME
- If you are a Nurse Director of Quality Management who is looking for an exciting and challenging career with a reputable Medical Center in beautiful and serene Washington state, look no further! The h...
- 19 Days Ago
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0 Utilization Management Director jobs found in Spokane, WA area
Hydropower System Engineer
- ANDRITZ
-
Spokane, WA
- Department: Project Management Reports To: Project Management Director Location: Charlotte or Spokane Supervisory respon...
- 4/24/2024 12:00:00 AM
Inland Marine Account Executive Officer/Senior Underwriter
- Travelers Insurance Company
-
Spokane, WA
- Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this...
- 4/24/2024 12:00:00 AM
Registered Nurse (RN)
- Prestige Care, Inc.
-
Spokane, WA
- What does the Registered Nurse (RN) do?: Simply put, this is the jump off point to a long and fruitful nursing career in...
- 4/23/2024 12:00:00 AM
Patent Paralegal
- FIG. 1
-
Spokane, WA
- Company Description FIG. 1 Patents is a law firm that specializes in building strategic patent portfolios for innovative...
- 4/23/2024 12:00:00 AM
Registered Nurse (RN)
- Prestige Care Inc.
-
Spokane, WA
- What does the Registered Nurse (RN) do?: Simply put, this is the jump off point to a long and fruitful nursing career in...
- 4/23/2024 12:00:00 AM
Registered Nurse (RN)
- Hiring Now!
-
Marshall, WA
- What does the Registered Nurse (RN) do?: Simply put, this is the jump off point to a long and fruitful nursing career in...
- 4/23/2024 12:00:00 AM
Registered Nurse (RN)
- Prestige Care Inc.
-
Veradale, WA
- What does the Registered Nurse (RN) do?: Simply put, this is the jump off point to a long and fruitful nursing career in...
- 4/23/2024 12:00:00 AM
Patent Paralegal
- Fig. 1
-
Spokane, WA
- Company Description FIG. 1 Patents is a law firm that specializes in building strategic patent portfolios for innovative...
- 4/21/2024 12:00:00 AM
About Spokane, Washington
Spokane (/ˌspoʊˈkæn/ (listen) spoh-KAN) is a city in Spokane County in the state of Washington in the northwestern United States. It is located on the Spokane River west of the Rocky Mountain foothills in eastern Washington, 92 miles (148 km) south of the Canada–US border, 18 miles (30 km) from the Washington–Idaho border, and 228 miles (367 km) east of Seattle along Interstate 90.
Known as the birthplace of Father's Day, Spokane's official nickname is the "Lilac City". A pink, double flower lilac variety known as 'Syringa Spokane' is named for the city. It is the seat of Spokane County and th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$129,095 to $174,562
Spokane, Washington area prices
were up 2.9% from a year ago
were up 2.9% from a year ago
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