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)
Full-Time Utilization Review/Risk Management Registered Nurse needed at a great hospital in beautiful northern New York
SIGN ON BONUS
POSITION TITLE: Quality Specialist
DEPARTMENT: Quality Management
REPORTS TO: Director of Quality Management
Job purpose: Provides Utilization Review and approval during the admission process and provides clinical information as required to Insurance Companies at admission and during stay. Works closely with Revenue Cycle staff and Discharge Planning to assist in the review and acceptance into the sub-acute rehab program. Coordinates the Quality Improvement monthly meetings and subsequent reports. Also coordinates the Risk Management process.
Qualifications:
Registered Nurse with current NYS License
Preferred experience with QI/Risk Management/Utilization Review/Infection Control
BSN Preferred
Familiar with agency support availability
PRI certification or within six months of employment
Offering competitive compensation and complete benefits.
For more information, please submit your resume for review
0 Utilization Management Director jobs found in Utica, NY area