Utilization Management Director jobs in District of Columbia

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 Assistant
  • medstar
  • Washington, DC FULL_TIME
  • Department: Utilization Review-DC Medicaid
    Status: Full-time, 40 hours per week, Non-exempt
    Schedule: Monday-Friday, 9:00am-5:30pm

    Must report on-site in office 1-2 times per week.

    Job Summary: 
     

    Provides administrative and other support to the Clinical Operations team of MedStar Family Choice. including accurate and efficient management of incoming calls and faxes. Responsible for managing outgoing correspondences and special projects to support the Clinical Operations process. 

    Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move! 

     
    Primary Duties: 

    • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. 

    • ACD Line management for the Clinical Operations Department. 

    • Actively manages incoming calls to collect appropriate information, assesses and identifies caller needs with efficiency and/or to courteously direct the calls to the appropriate staff in a timely manner per MFC's guidelines. 

    • Acts as a liaison to providers and members to communicate status of authorization decisions or need for additional information. 

    • Assists with MedStar Family Choice (MFC) Clinical Operations initiatives. This may involve; completing outreach to members, assisting with scheduling appointments, and/or removing identified barriers for members. Investigation may be required to locate members. Works collaboratively with the case management staff, clinical staff, and providers to assist members with compliance. 

    • Generates Local Health Department referrals and case management referrals when criteria are met. Assists with member surveys for case management programs. 

    • Assists with special mailings when indicated for case management programs. 

    • Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy. 

    • Ensures complete communication (closes the loop and follow up) between key internal and external customers. 

    • Enters data into the clinical software system related to pre-authorization requests for pharmacy, non-pharmacy, case management and hospitalizations. 

    • Maintains timely and accurate documentation in the clinical documentation system. 

    • Processes telephone inquiries and communicates accurate knowledge of benefits, policies and procedures. 

    • Projects a positive image on the telephone to internal and external customers. Represents the best of MedStar Family Choice (MFC) at all times and to all customers. 

    • Work collaboratively with the case management/ utilization management teams, and other customers internally and externally to meet the needs of the population. 

    • Participates in meetings and on committees and represents the department and hospital in community outreach efforts. 
       

    Qualifications: 

    • High School Diploma or GED required 

    • 6 months customer service experience in a managed care or social service setting required 

    • Medicaid experience preferred 

    • Knowledge of word processing, spreadsheet, database, and Microsoft PowerPoint 

    • Effective verbal and written communication skills required 

  • 13 Days Ago

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RN Case Manager/Utilization Management
  • Networks Connect Professional Staffing
  • Washington, DC FULL_TIME
  • Networks Connect Professional Staffing is conducting a search on behalf of our client for an RN Case Manager. Responsibilities: Conduct timely clinical reviews drawing upon appropriate resources and a...
  • 1 Day Ago

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Deputy Director - Case Management for Individual Assistance
  • Case Management for Individual Assistance - Tetra Tech Careers
  • Washington, DC FULL_TIME
  • Discover your full potential. At Tetra Tech, we are collaborating with industry-leading experts for a sustainable future for our world. We combine consulting and engineering with advanced analytics an...
  • 13 Days Ago

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Senior Strategy and Research Advisor
  • Office of the National Cyber Director
  • Washington, DC FULL_TIME
  • This position is located in the Executive Office of the President (EOP), Office of the National Cyber Director (ONCD), reporting to the Assistant National Cyber Director (ANCD) for Strategy and Resear...
  • 13 Days Ago

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Director of Risk Management
  • Walton Enterprises
  • Washington, DC FULL_TIME
  • Job Description Walton Enterprises (WEI) is seeking a skilled, highly motivated, and experienced individual to join its team as Director of Risk Management. Our Commitment to Diversity, Equity, Inclus...
  • 22 Days Ago

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Director of Programs Management
  • Pact, Inc.
  • Washington, DC OTHER
  • PACT OverviewPact is an international nonprofit that works in nearly 40 countries building solutions for human development that are evidence-based, data-driven and owned by the communities we serve. F...
  • 23 Days Ago

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Operational Risk Management Director -- Issues Management
  • MUFG (DBA)
  • New York, NY
  • Do you want your voice heard and your actions to count? Discover your opportunity with Mitsubishi UFJ Financial Group (M...
  • 3/29/2024 12:00:00 AM

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Managing Director
  • Bent Tree Partners LLC
  • 75010, TX
  • Job Description Job Description Project Manager for Agile and SDLC needs
  • 3/29/2024 12:00:00 AM

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Managing Director
  • Pointe Staffing Group
  • Denver, CO
  • Job Description Job Description Are you an Accounting/Audit leader? A builder of relationships and teams? An entrepreneu...
  • 3/29/2024 12:00:00 AM

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Managing Director
  • SpartaCraft
  • Connelly Springs, NC
  • Job Description Job Description SpartaCraft, a contract wood products and finishing company in Connelly Springs, NC is l...
  • 3/28/2024 12:00:00 AM

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Managing Director, Product Management
  • Omnicom Media Group
  • New York, NY
  • Overview Job Description Annalect's 2,000+ innovators leverage data and technology to help clients across Omnicom build ...
  • 3/27/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Transamerica Premier Life Insurance Company
  • Nashville, TN
  • The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Artech L.L.C.
  • Fremont, CA
  • Artech is currently looking to hire an experienced Managing Director to join our expanding team in Fremont, CA (Hybrid)....
  • 3/25/2024 12:00:00 AM

Washington, D.C. is located in the mid-Atlantic region of the U.S. East Coast. Due to the District of Columbia retrocession, the city has a total area of 68.34 square miles (177.0 km2), of which 61.05 square miles (158.1 km2) is land and 7.29 square miles (18.9 km2) (10.67%) is water. The District is bordered by Montgomery County, Maryland to the northwest; Prince George's County, Maryland to the east; Arlington County, Virginia to the south; and Alexandria, Virginia to the west. The south bank of the Potomac River forms the District's border with Virginia and has two major tributaries: the An...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$140,586 to $190,098

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