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)
ERP International is seeking a Utilization Management Registered Nurse (RN) for a full-time position supporting the 2d Medical Group, Barksdale AFB, LA
Be the Best! Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military Members, their Families and Retired Military Veterans! ERP International is honored to have been named one of The Washington Post’s 2023 Top Workplaces!
* Excellent Compensation & Exceptional Comprehensive Benefits!* Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!
* Medical/Dental/Vision, STD/LTD/Life, Health Savings Account available, and more!* Annual CME Stipend and License/Certification Reimbursement!
* Matching 401K!
About ERP International, LLC: ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. ERP is an Equal Opportunity Employer - Disability and Veteran.
Schedule:
Monday - Friday, 9 hours between 7:00am and 5:00pm, with a one-hour lunch
No Weekends or Holidays
Duties: The duties include, but are not limited to the following;
Minimum Qualifications:
* Education: Minimum BSN from an accredited college or university* Experience: Six years of clinical nursing experience is required. One year of previousexperience in Utilization Management is required. Full time employment in a nursingfield within the last 36 months is mandatory. Knowledge, skills and computer literacy to interpret and apply medical carecriteria, such as InterQual or Milliman Ambulatory Care Guidelines.Must possess experience in performing prospective, concurrent, and retrospectivereviews to justify medical necessity for medical care to aid in collection and recoveryfrom multiple insurance carriers. Review process includes Direct Care and Purchase CareSystem referrals, ward rounds for clinical data collection, contacting providers to informthem of dollars lost for missing documentation, and providing documentation for appealsresolution. Possesses working knowledge of Ambulatory Procedure Grouping (APGs),Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9(ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
* Licensure: Current, full, active, and unrestricted RN license from any state.
* Life Support Certifications: AHA or ARC BLS Certification * Security:Must possess ability to pass a Government background check/security clearance.