Utilization Management Director jobs in Charleston, SC
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
RN Utilization Review Case Management FT Days
- East Cooper Medical Center
-
Mount Pleasant, SC
OTHER
-
RN Utilization Review Case Management Full Time Days Position Days
The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including:• Utilization Management services supporting medical necessity and denial prevention• Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy• Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
Responsibilities- Accurate medical necessity screening and submission for Physician Advisor review- Securing and documenting authorization for services from payers- Managing concurrent disputes- Collaborating with payers, physicians, office staff and ancillary departments- Timely, complete and concise documentation in the Tenet Case Management documentation system- Maintenance of accurate patient deomgraphic and insurance information- Identification and documentation of potentially avoidable days- Identification and reporting over and underutilizationTHE RN UTILIZATION REVIEW CASE MANANAGEMENT FULL TIME DAYS CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.
Education
Required: Graduate of an accredited school of nursing.Preferred: Academic degree in nursing (bachelor's or master's)Experience
Required: 2 years pf acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting.
Certification
Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.Preferred: Accredited Case Manager (ACM).Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.2403012585
- 8 Days Ago
Regional Director of Construction
- IRT Management
-
Charleston, SC
FULL_TIME
- We're currently seeking a Regional Director of Construction for our Southeast region of multi-family communities. The Regional Director of Construction ensures that the community/regions assigned to t...
- 29 Days Ago
Director Case Management
- VBeyond Healthcare
-
Charleston, SC
FULL_TIME
- Director Case Management, RN (Charleston, SC) [$100,107 - $140,088 annually] | Relocation Assistance | Sign-on Bonus: $20,000 Award-winning hospital seeking a passionate leader for its Case Management...
- 18 Days Ago
RN Director Case Management
- VBeyond Healthcare
-
Charleston, SC
FULL_TIME
- Director Case Management, RN (Charleston, SC)Location: Charleston, SCComp: $100,107.00 - $140,088.00● 15% Potential Bonus Incentive. ● Sign-On Bonus: $20,000Summary: Our award-winning client is seekin...
- 13 Days Ago
Director Case Management
- Trident Medical Center
-
Charleston, SC
FULL_TIME
- ** $20,000 sign on bonus offered for non-HCA employees** Introduction Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Director Case Managem...
- 14 Days Ago
Director Case Management
- Texas Nursing Services
-
Charleston, RI
FULL_TIME
- Director Case Management 📍 Charleston, SC💼 Competitive Salary $102,107.00 - $204,069.00.| 💰 Bonus Incentives| 🌟 Sign-On Bonus: $20,000| 🚚 Relocation AssistanceOverview: Lead with passion and expe...
- 1 Month Ago
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0 Utilization Management Director jobs found in Charleston, SC area
Engineering Program Manager
- Ainsley Search Group
-
Goose Creek, SC
- Ainsley Search Group is hiring a Engineering Program Manager with experience managing engineering projects to join a Glo...
- 4/24/2024 12:00:00 AM
Aviation Project Manager
- Johnson, Mirmiran & Thompson
-
Mount Pleasant, SC
- Johnson, Mirmiran & Thompson is a dynamic, 100% employee-owned consulting firm of more than 2,000 professionals that pro...
- 4/24/2024 12:00:00 AM
Lead and Copper Regional Lead-Charlotte,NC
- Black & Veatch
-
Charleston, SC
- **Lead and Copper Regional Lead-Charlotte,NC**Date: Mar 27, 2024Location:Charlotte, TX, US USCompany: Black & Veatch Fam...
- 4/24/2024 12:00:00 AM
Senior Accountant
- Redwood Materials
-
Ridgeville, SC
- Senior Accountant We are seeking a Senior Accountant with experience assessing business expenses and to assist in prepar...
- 4/23/2024 12:00:00 AM
Director of Finance And Accounting
- Hyatt Hotels Corporation
-
Isle of Palms, SC
- Wild Dunes Resort Nestled on the northern tip of Isle of Palms, a lush barrier island off the coast of South Carolina, W...
- 4/22/2024 12:00:00 AM
Managing Director, Investment Compliance & Risk
- Greystar Worldwide, LLC
-
Charleston, SC
- About Greystar: Greystar is a leading, fully integrated real estate company offering expertise in investment management,...
- 4/21/2024 12:00:00 AM
Senior Program Manager
- Advanced Technology International
-
Summerville, SC
- Vacancy Name Senior Program Manager Vacancy No VN495 Employee Type Full-time Location City Summerville Education Level B...
- 4/21/2024 12:00:00 AM
Director of Finance And Accounting
- Hyatt Hotels Corporation
-
Isle Of Palms, SC
- Wild Dunes Resort Nestled on the northern tip of Isle of Palms, a lush barrier island off the coast of South Carolina, W...
- 4/21/2024 12:00:00 AM
About Charleston, South Carolina
Charleston is the oldest and largest city in the U.S. state of South Carolina, the county seat of Charleston County, and the principal city in the Charleston–North Charleston–Summerville Metropolitan Statistical Area. The city lies just south of the geographical midpoint of South Carolina's coastline and is located on Charleston Harbor, an inlet of the Atlantic Ocean formed by the confluence of the Ashley, Cooper, and Wando rivers. Charleston had an estimated population of 134,875 in 2017. The estimated population of the Charleston metropolitan area, comprising Berkeley, Charleston, and Dorche...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$120,235 to $162,582
Charleston, South Carolina area prices
were up 1.5% from a year ago
were up 1.5% 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