Utilization Management Director jobs in Caldwell, ID

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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Post Acute Care Utilization Management Advisor
  • St. Luke's Health System
  • Boise, ID FULL_TIME
  • Overview

    St. Luke’s Health System is seeking a Post-Acute Care Advisor to join our Health Partners team. This role offers a variety of flexibility including the ability to work remotely (within healthcare parameters) with no on-call obligations! 

     

    POSITION SUMMARY

    The Care Advisor works with physicians and multidisciplinary care team members to assess patient needs and develop a care plan. The Care Advisor uses assessment skills and appropriate risk assessment tools to identify patients with actual or potential health care needs that would require post-acute care coordination. This position collaborates with interdisciplinary teams in establishing mutual goals based on the patient's needs or problems. The Care Advisor evaluates, compares and interprets ambiguous and changing clinical patient data. This individual explores patient's understanding and knowledge of current health status.

     

    WHAT WILL I DO? This position will decrease variability and waste by standardizing rehabilitation and medical care in coordination with hospitals and post-acute care facilities.  You will actively manage the engagement of hospital care teams and the care teams in skilled nursing facilities. This is a system-wide role that supports hospital discharge planning and enhances coordination of post-acute care and outcomes in a cost-effective manner. The person needs to have strong interpersonal skills, be very detailed, and have excellent communication skills. Also, must be willing to have fun, work hard, and have a true passion to help solve problems and help others!

     

    ABOUT ST. LUKE’S HEALTH PARTNERS

    St. Luke’s Health Partners is an Idaho-based financially and clinically integrated network of providers who share a vision to help its members achieve the best possible health at the lowest total cost of care.  SLHP is accountable for the management of medical spend and quality outcomes of defined populations through value-based agreements with payer partners.  The selective network of nearly 2,800 providers is currently serving more than 160,000 Idahoans.

     

    WHY ST. LUKE’S?

    St. Luke’s Health System is Idaho’s largest employer and most awarded health system, with a medical staff of over 1,800 physicians and advanced practice providers. Made up of eight hospitals around central and southern Idaho, we are proud to be the only locally owned and operated, physician-led, not-for-profit health system in the state. St. Luke’s has been awarded as one of the Top 15 Health Systems in the country for the fifth consecutive year, designated by Truven Health Analytics. We are committed to providing high quality patient care and positively impacting the lives of those in our community. St. Luke’s enjoys an outstanding reputation as both a quality employer and a superior healthcare organization.

    Responsibilities

    • Works closely with the physician, care team and payers in the management of identified patient populations to reduce the total cost of care and optimize patient outcomes.
    • Conducts comprehensive screenings of patients in the hospital and collaborates with care teams to ensure appropriate placement from the acute care setting to the post-acute care setting.
    • Evaluates patient insurance resources including, but not limited to Medicare, Medicaid, HMO and commercial insurances and makes post-acute care placement recommendations for appropriate utilization.
    • Establishes and maintains a supportive, collegial role with assigned post-acute care facilities and engages in performance improvement activity.
    • Collects and tracks data related to target populations.
    • Implements interventions based on data and established guidelines.
    • Serves as a subject matter expert on the post-acute care continuum of services and the application of cost to all levels of care, length of stay and outcomes.
    • Performs other duties and responsibilities as assigned.

    Qualifications

    • Education: Bachelors’ Degree in Nursing or Social Work
    • Experience: 6 years relevant work experience, including 2 years’ experience in care management or working for a skilled nursing facility, home health or hospice agency, rehabilitation hospital, long-term care hospital (LTCH), or Payer
    • Licenses/Certifications: Must have current licensure in one of the following:
      • Registered Nurse in the State of Idaho OR
      • Licensed Master Social Worker

    Preferred Qualifications: 

    • Payer experience highly desired
    • For Social Workers, LMSW or LCSW is preferred

    Why St. Luke's

    A strong, talented staff is at the heart of St. Luke’s Health System. We are the state’s largest employer with more than 15,000 employees and a medical staff of more than 1,800 physicians and advanced practice providers. We’re proud of our people who deliver skilled, compassionate care every day, and are looking to add dedicated individuals who will continue this same tradition of excellence.

     

    For more information, please contact Julie Leguineche at leguinej@slhs.org 

     

    ABOUT TWIN FALLS

    Located in Southern Idaho, just under two hours from Boise, Twin Falls offers four distinct seasons and is best known for Shoshone Falls - "Niagara of the West" - and bountiful outdoor adventures. Adventure seekers here can enjoy whitewater rafting, kayaking, rock-climbing and BASE jumping from Perrine Bridge. Twin Falls has a thriving agriculture-based economy, which powers its reputation as a preferred location for food science, production and processing companies. Local schools receive strong support from the community in both academics and sports, while also enriching the community's arts and culture scene. With a low crime rate, good schools and endless opportunities for the outdoor enthusiast, you’ll find Twin Falls is unhurried, unspoiled and unassuming.

     

    Learn more about what the Magic Valley has to offer you:

    City of Twin Falls | Perrine Bridge | Shoshone Falls | Snake River Canyon Rim Trails | Dierkes Lake | Idaho Heritage Museum | Herrett Center for Arts and Sciences | Orpheum Theatre | Faulkner Planetarium | Twin Falls Parks and Rec | Twin Falls Golf Club | Farmer's Market | Pomerelle Ski Resort | Balanced Rock | City of Rocks | Thousand Springs | Magic Valley Symphony | Sawtooth National Forest 

     

    About Boise

    Known as the "City of Trees," Boise is Idaho's capital city—both a cultural center and a playground for those who love the outdoors. A vibrant downtown area affords fine dining, theatre, music, and college and semi-professional sports.  Downtown Boise's main attractions include the Idaho State Capitol, the classic Egyptian Theatre, the Boise Art Museum, Julia Davis Park and Zoo Boise.  The Greenbelt follows the beautiful Boise River corridor for more than 30 miles, and the Boise foothills are home to miles of hiking and biking trails.  

     

    Learn more about what the City of Trees has to offer you: 

    St. Luke’s Health System | Boise Convention and Visitors Bureau | Boise Parks and Recreation | Boise Museum Association | Boise Music Festival | Boise Philharmonic | Downtown Boise Restaurants | Boise Valley Economic Partnership | Hyde Park events | Treefort Music Festival | First Thursdays | Alive After Five | Capitol City Public Market | Runs and Triathlons | Shakespeare Festival | Sawtooth National Forest | Visit Idaho.org 

     

    *St. Luke’s is an equal opportunity employer without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

  • 1 Month Ago

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Operations Director- Property Management
  • Balfour Beatty Investments & Communities
  • Mountain Home, ID FULL_TIME
  • Who we are At Balfour Beatty Communities, we are dedicated to a singular mission: delivering the quality communities people are proud to call home. We believe exceptional living experiences can only b...
  • 1 Month Ago

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Operations Director- Property Management
  • Balfour Beatty Investments - North America
  • Mountain Home, ID FULL_TIME
  • Who we are At Balfour Beatty Communities, we are dedicated to a singular mission: delivering the quality communities people are proud to call home. We believe exceptional living experiences can only b...
  • 1 Month Ago

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Director of Care Coordination
  • Clinical Management Consultants
  • Boise, ID FULL_TIME
  • A new and exciting opportunity for a Director of Care Coordination has just become available at a 25 bed critical access hospital in Northern Idaho! Come join a leading healthcare organization committ...
  • 5 Days Ago

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Director Product Management, Data Strategy
  • Pearson
  • Boise, ID FULL_TIME
  • Director of Product Management – Data Strategy Pearson is the world’s learning company. We help people of all ages acquire the knowledge and skills they need to be successful in their work and careers...
  • 15 Days Ago

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Operations Director ( Residential Property Management)
  • Balfour Beatty Communities
  • Mountain Home, ID FULL_TIME
  • The Operations Director plays a vital role in providing installation leadership and oversight of the property’s operations for both community and facility management to achieve the highest levels of e...
  • 15 Days Ago

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0 Utilization Management Director jobs found in Caldwell, ID area

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Marketing Director & Brand Manager
  • Amherst Madison
  • Boise, ID
  • Please submit a cover letter with your resume. Any applications without a cover letter will not be viewed. Linkedin will...
  • 4/25/2024 12:00:00 AM

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Marketing Director & Brand Manager
  • Amherst Madison
  • Boise, ID
  • Please submit a cover letter with your resume. Any applications without a cover letter will not be viewed. Linkedin will...
  • 4/24/2024 12:00:00 AM

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Executive Director
  • Catholic Recruiter Associates
  • Boise, ID
  • Executive Director: Catholic Charities of Idaho The Executive Director provides overall leadership and management of Cat...
  • 4/24/2024 12:00:00 AM

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Sr. Manager / Director, Dry Etch Equipment Development
  • Micron
  • Garden City, ID
  • Our vision is to transform how the world uses information to enrich life for all .Micron Technology is a world leader in...
  • 4/23/2024 12:00:00 AM

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People Director Union Labor Relations
  • Idaho State Job Bank
  • Boise, ID
  • People Director Union Labor Relations at CBRE in Boise, Idaho, United States Job Description People Director Union Labor...
  • 4/23/2024 12:00:00 AM

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Sr. Manager / Director, Dry Etch Equipment Development
  • Micron Technology
  • Boise, ID
  • Our vision is to transform how the world uses information to enrich life for all. Micron Technology is a world leader in...
  • 4/22/2024 12:00:00 AM

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Purchasing Assistant (Full Time)
  • D&B SUPPLY LLC
  • Caldwell, ID
  • Job Details Job Location Main Office - Caldwell, ID Position Type Full Time Description Who We Are We are a leading farm...
  • 4/22/2024 12:00:00 AM

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Project Delivery Manager - Datacenter System Admin and Ops Manager - TSP
  • Idaho State Job Bank
  • Boise, ID
  • Project Delivery Manager - Datacenter System Admin and Ops Manager - TSP at Deloitte in Boise, Idaho, United States Job ...
  • 4/22/2024 12:00:00 AM

Caldwell (locally /ˈkɑːlwɛl/) is a city in and the county seat of Canyon County, Idaho, United States. The population was 46,237 at the 2010 census. Caldwell is considered part of the Boise metropolitan area. Caldwell is the location of the College of Idaho and College of Western Idaho. Caldwell is located at 43°39′30″N 116°40′49″W / 43.65833°N 116.68028°W / 43.65833; -116.68028 (43.658239, -116.680390). According to the United States Census Bureau, the city has a total area of 22.11 square miles (57.26 km2), of which, 22.06 square miles (57.14 km2) is land and 0.05 square miles (0.13 km2)...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$116,312 to $157,277
Caldwell, Idaho area prices
were up 2.5% 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