Utilization Management Director jobs in Kentucky

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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Case Management Specialist - Utilization Review
  • Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary

    Job Summary

    Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and providing guidance, education, and support to assigned patients.
     
    Job Responsibilities
    • Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
    • Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
    • Provides appropriate clinical information to payers as requested within specified time frame.
    • Collaborates with the Physician, Medical Director, Director, Manager, and Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization.
    • Delivers regulatory letters to patients as needed.
    • Provides education and acts as a resource for physicians, staff, and patients/families regarding utilization review processes.
    • Trains new case managers, students, and interns as needed.
    Qualifications
    • Associate's degree or higher in Nursing required upon hire AND
    • Bachelor's degree or higher in Nursing required within 5 years of employment in this position
    • No experience required
    • RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire
    Skills and Attributes
    • Requires critical thinking skills and decisive judgment.
    • Works under minimal supervision.
    • Must be able to work in a stressful environment and take appropriate action.
    Physical Demands
    • Standing: Occasionally
    • Walking: Occasionally
    • Sitting: Frequently
    • Lifting 0-25 lbs: Rarely
    • Lifting 25-75 lbs: Never
    • Lifting over 75 lbs: Never
    • Carrying 0-25 lbs: Rarely
    • Carrying 25-75 lbs: Never
    • Carrying over 75 lbs: Never
    • Pushing/Pulling 0-25 lbs: Rarely
    • Pushing/Pulling 25-75 lbs: Never
    • Pushing/Pulling over 75 lbs: Never
    • Climbing: Rarely
    • Bending/Stooping: Rarely
    • Kneeling: Rarely
    • Crouching/Crawling: Rarely
    • Reaching: Occasionally
    • Talking: Frequently
    • Hearing: Occasionally
    • Repetitive Foot/Leg Movements: Never
    • Repetitive Hand/Arm Movements: Frequently
    • Keyboard Data Entry: Frequently
    • Running: Never
    • Vision: Depth Perception: Frequently
    • Vision: Distinguish Color: Frequently
    • Vision: Seeing Far: Frequently
    • Vision: Seeing Near: Frequently
    Owensboro Health Core Commitments

    INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

    RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

    TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

    INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

    SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

    EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.
  • 8 Days Ago

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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 d...
  • 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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RN - Weekend Utilization Management (Fri-Sun 7a-7p)
  • Humana
  • UNKNOWN, KY FULL_TIME
  • Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of m...
  • 3 Days Ago

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Behavioral Health Care Advocate (Utilization Management) - Remote (IN or KY License Required)
  • UnitedHealth Group
  • Louisville, KY FULL_TIME
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connectin...
  • Just Posted

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Manager - Utilization Management Behavioral Health - Remote - Louisville, KY
  • Humana
  • UNKNOWN, KY FULL_TIME
  • Become a part of our caring community and help us put health first The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support the coordination, do...
  • 3 Days Ago

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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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Health Information Management Director
  • Clinical Management Consultants
  • Waterflow, NM
  • Calling all Health Information Management professionals looking to advance their career by joining an award winning hosp...
  • 3/28/2024 12:00:00 AM

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Case Management Director
  • Clinical Management Consultants
  • Plainview, TX
  • An award winning medical center is searching for a strong, experienced Case Management Director. Our team is excited to ...
  • 3/25/2024 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 Relationship Manager-MMB
  • First Citizens Bank
  • Santa Monica, CA
  • Overview: First Citizens Middle Market Banking delivers a range of financial solutions to midsize clients through a rela...
  • 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

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Managing Director
  • Selby Jennings
  • Chicago, IL
  • Join a dynamic and growing team at our Client; A premier financial services firm specializing in middle-market transacti...
  • 3/24/2024 12:00:00 AM

Kentucky (/kənˈtʌki/ (listen) kən-TUK-ee), officially the Commonwealth of Kentucky, is a state located in the east south-central region of the United States. Although styled as the "State of Kentucky" in the law creating it, (because in Kentucky's first constitution, the name state was used) Kentucky is one of four U.S. states constituted as a commonwealth (the others being Virginia, Pennsylvania, and Massachusetts). Originally a part of Virginia, in 1792 Kentucky became the 15th state to join the Union. Kentucky is the 37th most extensive and the 26th most populous of the 50 United States. Ke...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$118,839 to $160,691

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