Seeking Utilization Management Director to oversee all phases of development, organization, planning and implementation of projects on processes to enhance quality-driven outcomes.
UM Director will provide vision and strategy for inpatient utilization and prior authorization management activities designed to achieve quality and service-driven objectives.
UM Director will serve as a key member in the Health Services leadership team and work in collaboration with our Medical Director and VP, to assist in identifying and then implementing strategies to correct trends of either over or under utilization.
Education, Experience and Qualifications of the UM Director:
Licensed Registered Nurse (RN)
Bachelor's Degree in Nursing (BSN), Health Administration, Healthcare Policy & Informatics or business-related field
Utilization review/management certification preferred, or equivalent professional certification
5+ Years of management experience in a managed health care setting
7+ years of experience in acute clinical/surgical experience preferred
5+ years of experience in progressively challenging positions preferred
Other current experience in utilization management to include pre-authorization, utilization review, concurrent review, discharge planning, and/or skilled nursing facility reviews