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)
The Director of Utilization Management provides leadership, management, oversight, and assessment of all aspects of management and is responsible for managing overall utilization while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of UM works collaboratively with the Chief Medical Officer, Vice President of Medical Economics, Program Evaluation and Clinical Strategic Initiatives, Director of Case Management and Medical Directors, as well as other leaders to plan, organize, coordinate, develop the vision, perform implementation and measure the outcomes of all UM and A/G programs based on both governmental and non-governmental lines of business to ensure compliance to the requirements of all regulatory and accreditation bodies relevant to clinical management.
Required:
Desired:
Responsibilities: