Utilization Management Director jobs in Rhode Island

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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Nurse Reviewer / Utilization Management
  • MEDuvi LLC
  • Providence, RI FULL_TIME
  • Nurse Reviewer -Utilization Management
    3-6 Month Contract / Temp to Perm
    ** Candidates Must have active Rhode Island Nursing License**
    • Conduct pre and post payment review of inpatient admissions, outpatient services, and other procedures to assess the medical necessity and appropriateness of services on-site or in-house.
    • Discuss cases with attending physician and other health care professionals.
    • Prepare and refer concerns to plan Medical Directors.
    • Medical reviews, including pre-authorization, concurrent review, screening for quality-of-care issues, and discharge planning.
    • Document rationale for medical decisions made.
    • Monitor and evaluate patient’s plan of care and identify potential issues, recommend appropriate interventions if needed.

    Suggested Experience / Requirements
    • Unrestricted Rhode Island Nursing License
    • 3 years of acute medical or clinical experience or experience in utilization reviews
    • Understanding of utilization review techniques including all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning
    • Advanced analytical skills, with the ability to interpret and synthesize complex data sets
    • Excellent verbal and written communications skills, negotiation skills, presentation skills
    • Excellent organizational skills and ability to prioritize multiple tasks
    EEO Statement. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
  • 19 Days Ago

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Director of Facilities Management
  • Staffeagle llc
  • Smithfield, RI FULL_TIME
  • TITLE: Director of Facilities Management JOB TYPE: Full Time / Direct Hire LOCATION: Smithfield RI SALARY: $100K (Negotiable and not a constraint for the best fit and deserving candidate) JOB DESCRIPT...
  • Just Posted

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Director, Facilities Management
  • Snaprecruit.com
  • Smithfield, RI FULL_TIME
  • Job Title : Director Facilities Location : Smithfield, RI Duration : Permanent Hire Job Description : The ideal candidate will have: Strong technical knowledge of the following: mechanical, electrical...
  • Just Posted

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Director of Digital Product Management
  • Arrow Electronics
  • Island, RI FULL_TIME
  • Description Arrow Electronics is a global provider of products, services, and solutions to industrial and commercial users of electronic components and enterprise computing solutions. Arrow Electronic...
  • 1 Day Ago

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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...
  • 3 Days Ago

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Facilities Management Director
  • Encompass Health
  • Johnston, RI OTHER
  • Facilities Management Director Tremendous professional abilities Truly meaningful results BE THE CONNECTION. In your role as facilities maintenance director, you'll have the opportunity to be the conn...
  • 3 Days Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$132,352 to $178,964

Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
February 09, 2020
Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
February 18, 2020
Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019