Utilization Management Director jobs in Maryland

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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Director of Case Management and Utilization
  • medstar
  • Clinton, MD FULL_TIME
  • MedStar Health is looking for a Director of Case Management and Utilization to join our team! We are looking for a registered nurse or social worker with the ability to demonstrate ethical behavior that supports the hospital’s mission, values, and commitment to compliance with all federal, state, and regulatory laws. Inspires trust and exhibits honesty and integrity within the scope of daily activities. 

    The Director of Case Management and Utilization will develop, implement, and evaluate the strategic plan for the hospital-wide Case Management process. Provide operational supervision of case management department. Coordinate and support ongoing problem solving. Establish tools, processes, and systems to optimize the individual roles of the department. 

    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: 

    • Responsible for assuring compliance with hospital wide patient care quality monitoring in collaboration with the Performance Improvement Department. Assures performance improvement activities with ongoing monitors for the Case Management Department. Knowledge of the organization’s performance improvement priorities and outcomes. Assists the organization to achieve compliance in the Important Functions described in the Joint Commission.  

    • Provides direct supervision of utilization management activities as mandated by State/Federal regulations. Assures utilization criteria and monitors are approved by Medical Staff as appropriate. Maintains the program to assure coordination of patient services and financial issues related to reimbursement for care provided with all Managed Care Companies and outside providers. Assist Utilization Management Committee Chairman to prepare for meetings and comply with regulatory requirements. Assures appeals system is maintained and will coordinate with the Business Office for maximum reimbursement.  

    • A member of the Hospital Ethics Committee, the Clinical Pathways Committee, Medical Records Committee, and the Performance Improvement Committee. Implements changes and maintains systems for statistical reporting of Utilization Review activities and develops outcomes documentation and reporting as the Case Management program evolves. Maintains ongoing communication with staff on the nursing units to address concerns relative to Case Management issues. Responsible for ongoing education of medical staff, nursing, and other ancillary services effected by development of and changes to the Case Management program in keeping with the changing health care environment.  

    • Assures ongoing communication with key departments/providers to assure negotiation/facilitation of patient movement through the health care system. Provides daily ongoing supervision of Case Managers and the Social Workers for case management problems direction and resolution. Plans and participates in staff development as appropriate. Responsible for personnel function of the Department including work performance and recommendations regarding personnel actions for professional and support staff.  

    • Monitors and controls departmental utilization of hospital resources and makes recommendations to the Vice President of Professional Services regarding planned budgetary departmental needs and requirements. Maintains confidentiality in accordance with hospital policy. Communicates effectively and courteously with all patients, families, visitors, physicians, and hospital staff 

     

    Qualifications:  

    • Master’s degree in Health Administration, Business Administration, Science of Nursing or Social Work. 

    • 5-7 years' experience in utilization management, discharge planning, quality management or case management. 

    • 3-4 year’s clinical experience in an acute care setting. 

    • Management experience. 

    • Certification in Case Management required. 

    • RN or Social Work Licensure in Maryland required. 

  • 17 Days Ago

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Associate Director Quality Control
  • 10000929 - Assoc Director Study Management
  • Rockville, MD FULL_TIME
  • Are you ready to take the lead in ensuring the hard work from the rest of the business is realized, as we reliably get every medicine out to patients without challenge? We are looking for an Associate...
  • 9 Days Ago

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Utilization Review - Non Exempt
  • Utilization Review - 630
  • Baltimore, MD FULL_TIME
  • Utilization Review - 630As NeededDay 8 Hour Shifts (8:30 am-5:00 pm)0Req# 43127 JOB DESCRIPTION SUMMARY: Under general supervision, utilize clinical knowledge and critical thinking skills to provide o...
  • 19 Days Ago

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Senior Director Risk Management, Patient Safety Centre of Excellence
  • 10001069 - Director Patient Safety Sci
  • Gaithersburg, MD FULL_TIME
  • Introduction to role:Are you a seasoned professional in Risk Management with a broad knowledge in patient safety? Do you have the ability to provide leadership and strategic direction to the developme...
  • 17 Days Ago

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Utilization Management Coordinator - II
  • Progressive Technology Solutions
  • Owings Mills, MD CONTRACTOR
  • General Information Job Description: PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utiliz...
  • 12 Days Ago

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PRN Utilization Management
  • Johns Hopkins Medicine
  • Bethesda, MD PART_TIME
  • One organization. Countless opportunities. Suburban Hospital is a 228-bed, not-for-profit, community-based hospital in Bethesda, Maryland. Suburban Hospital is a member of Johns Hopkins Medicine and h...
  • 13 Days Ago

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Managing Director, Practice Management - Private Equity
  • Goodwin Procter LLP
  • Boston, MA
  • Make an impact at Goodwin, where we partner with our clients to practice law with integrity, ingenuity, agility and ambi...
  • 3/29/2024 12:00:00 AM

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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
  • 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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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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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
  • 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

Maryland (US: /ˈmɛrələnd/ (listen) MERR-əl-ənd) is a state in the Mid-Atlantic region of the United States, bordering Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware to its east. The state's largest city is Baltimore, and its capital is Annapolis. Among its occasional nicknames are Old Line State, the Free State, and the Chesapeake Bay State. It is named after the English queen Henrietta Maria, known in England as Queen Mary. Sixteen of Maryland's twenty-three counties border the tidal waters of the Chesapeake Bay estuary and...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$130,212 to $176,071

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