Utilization Management Director jobs in Covington, KY

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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Utilization Management Specialist 1
  • SUN Behavioral Kentucky
  • Erlanger, KY FULL_TIME
  • Position Summary:

    Responsible for the coordination of case management strategies pursuant to the Case Management process. Assists and coordinates care of the patient from pre-hospitalization through discharges. Responsible for assisting with authorization of admissions to hospital. Processes retroactive reviews and appeals, copies needed documentation and writes retro/appeal letters for insurance companies to ensure coverage for patient admissions. Conducts follow up calls with insurance companies to ensure coverage for patient admissions. Participates in performance improvement activities. Attends 80% of staff meetings. Coordinates care for patient through communication with Physicians, Nurse Practitioners, Clinical Services, Nursing, Assessment and Referrals Department.

    Position Responsibilities:

    Clinical / Technical Skills (40% of performance review)

    • Provides thorough documentation and timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews and discharges; including case s with limited benefits, cases in peer review/denial and /or unplanned discharges
    • Coordinates with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Document s and updates the denial log to reflect same.
    • Consults Business Office and/or admission staff as needed to clarify data and ensure authorization processes are complete.
    • Documents in EMR the results of admission and concurrent reviews.
    • Stays informed about changes in Medicare and Medicaid.
    • Ability to stage local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.
    • Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
    • Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Oversees continuity of care for each level of care transition.
    • Develops and maintains processes to minimize denials and communication of same to CFO and Business Office Director.
    • Reports results of daily treatment team meetings all discharges and status of high-risk case such as limited benefits, peer reviews, denials or unplanned discharges.
    • Timely retroactive reviews and appeals within current month
    • Strong knowledge of external review organizations (i.e.: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
    • Types and mails all correspondence in a timely manner.
    • Answers the telephone in a polite manner, Communicates information to the appropriate staff.
    • Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage.
    • Support discharge planning and utilization review when necessary
    • Perform other duties as required

    Safety (15% of performance review)

    • Strives to create a safe, healing environment for patients and family members
    • Follows all safety rules while on the job.
    • Reports near misses, as well as errors and accidents promptly.
    • Corrects minor safety hazards.
    • Communicates with peers and management regarding any hazards identified in the workplace.
    • Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
    • Participates in quality projects, as assigned, and supports quality initiatives.
    • Supports and maintains a culture of safety and quality.

    Teamwork (15% of performance review)

    • Works well with others in a spirit of teamwork and cooperation.
    • Responds willingly to colleagues and serves as an active part of the hospital team.
    • Builds collaborative relationships with patients, families, staff, and physicians.
    • The ability to retrieve, communicate, and present data and information both verbally and in writing as required
    • Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
    • Demonstrates adequate skills in all forms of communication.
    • Adheres to the Standards of Behavior

    Integrity (15% of performance review)

    • Strives to always do the right thing for the patient, coworkers, and the hospital
    • Adheres to established standards, policies, procedures, protocols, and laws.
    • Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
    • Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
    • Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
    • Exemplifies professionalism through good attendance and positive attitude, at all times.
    • Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
    • Ensures proper documentation in all position activities, following federal and state guidelines.

    Compassion (15% of performance review)

    • Demonstrates accountability for ensuring the highest quality patient care for patients.
    • Willingness to be accepting of those in need, and to extend a helping hand
    • Desire to go above and beyond for others
    • Understanding and accepting of cultural diversity and differences

    Education

    • Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.
    • Preferred: Associates or Bachelors degree.
    • Maintains education and development appropriate for position.
    • May substitute experience for education

    Experience

    • Required: One year of experience in a behavioral healthcare setting.
    • Preferred: Previous experience in a Utilization Management department or as a Mental Health Tech
    • May substitute education for experience
  • 19 Days Ago

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Utilization Management Specialist 1
  • SUN BEHAVIORAL HEALTH GROUP
  • Erlanger, KY OTHER
  • Job Details Job Location: SUN Behavioral Kentucky - Erlanger, KY Position Type: Part Time Education Level: High School/GED Salary Range: Undisclosed Travel Percentage: None Job Shift: Days Job Categor...
  • 16 Days Ago

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Corporate Director of Case Management
  • Lionstone Care Management
  • Cincinnati, OH FULL_TIME
  • At Lionstone Care Management, we’re raising the bar on assisted living and skilled nursing care. Welcome to the Lionstone Care family of facilities, where residents, staff, and management unite to for...
  • 22 Days Ago

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Dining service director
  • Grace Management
  • Cincinnati, OH FULL_TIME
  • Pay starting at $60,000 / year Northgate Park seeks compassionate and caring individuals who are dedicated to supporting exceptional senior living experiences. Working at Northgate Park means you are ...
  • Just Posted

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Director, Account Management
  • Medpace, Inc.
  • Cincinnati, OH OTHER
  • Job Summary Our corporate activities are growing rapidly, and we are currently seeking a full-time, office-based Director, Account Management to join our Commercial Operations team. Responsibilities O...
  • 21 Days Ago

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Director, Reporting & Data Management
  • FIS Global
  • Cincinnati, OH OTHER,FULL_TIME
  • Position Type : Full time Type Of Hire : Experienced (relevant combo of work and education) Education Desired : Bachelor's Degree Travel Percentage : 0%Job DescriptionAbout the role:We are looking for...
  • 21 Days Ago

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0 Utilization Management Director jobs found in Covington, KY area

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Quality Supervisor
  • Catalent Pharma Solutions, Inc.
  • Lawrenceburg, IN
  • Quality Assurance Supervisor Position Summary Catalent is a global, high-growth, public company, and a leading partner f...
  • 3/29/2024 12:00:00 AM

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Restaurant Area Director / District Manager
  • ResourceOne
  • Cincinnati, OH
  • Job Description Job Description Looking for a Restaurant Area Director or District Managerthat wants to grow your career...
  • 3/28/2024 12:00:00 AM

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Hourly Manager- Norwood
  • FORD'S GARAGE 01070
  • Cincinnati, OH
  • Reports to: General Manager/Director of Operations/Executive VP Operations JOB SUMMARY: Our mission is to provide an inn...
  • 3/28/2024 12:00:00 AM

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Senior Director, Consulting
  • NTT DATA Business Solutions
  • Cincinnati, OH
  • Position Description: As the People Leader for a team of consultants specializing in SAP functionality, business process...
  • 3/27/2024 12:00:00 AM

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Hot Head Burritos - Manager
  • Hot Head Burritos
  • West Chester, OH
  • As manager, you'll be responsible for overseeing daily operations of the restaurant. You should prioritize outstanding g...
  • 3/26/2024 12:00:00 AM

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Grant Administrator
  • Cincinnati-Hamilton County Community Action Agency
  • Cincinnati, OH
  • Job Description Job Description Researches, plans, develops, and implements strategies to obtain financial resources thr...
  • 3/26/2024 12:00:00 AM

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Senior Director, Consulting
  • Ntt Data Business Solutions
  • Cincinnati, OH
  • Position Description: As the People Leader for a team of consultants specializing in SAP functionality, business process...
  • 3/26/2024 12:00:00 AM

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Director Of Residential Operations
  • PrideStaff Financial
  • Alexandria, KY
  • PrideStaff Financial is bringing this opportunity for a go getter, someone looking to serve challenged youth with the se...
  • 3/25/2024 12:00:00 AM

Covington is a city in Kenton County, Kentucky, United States, located at the confluence of the Ohio and Licking Rivers. Cincinnati, Ohio, lies to its north across the Ohio and Newport, Kentucky, to its east across the Licking. Part of the Cincinnati–Northern Kentucky metropolitan area, Covington had a population of 40,640 at the time of the 2010 U.S. census, making it the fifth-most populous city in Kentucky. It is one of its county's two seats, along with Independence. According to the United States Census Bureau, Covington has a total area of 13.7 square miles (35 km2), of which 13.1 square...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$123,499 to $166,993
Covington, Kentucky area prices
were up 1.1% 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