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)
The Precertification Specialist II is responsible for overseeing the completion of authorizations. The Specialist acts as the liaison between providers, physicians, insurance companies, billing department, and utilization review companies to ensure the initiation and/or completion of all payers requiring precertification
Job Description:
Required Qualifications:
Education: High School Diploma or GED equivalent.
Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.
Memorial Health System has been dedicated to healing, inspiring, and transforming the health of our community since 1946. With multiple hospital facilities, outpatient surgery locations and diagnostic centers, more than 100 Physician Clinics, and post-acute services including skilled nursing, you can find your fit at Memorial.
When you join our team, you join more than 5,000 individuals committed to exceptional care. We offer several of the region's most comprehensive clinical programs and medical specialties unique to the Coast, including a Level III Neonatal ICU, state-designated Level II Trauma Center, Hyperbaric Oxygen Therapy, and Mississippi's first nationally-certified Primary Stroke Center.
At Memorial, you are valued. We know that our increasingly diverse communities need healthcare professionals that reflect their different cultural backgrounds, perspectives, and values. We acknowledge the uniqueness of all individuals, their commonalities as well as differences, all of which have shaped their lives in meaningful ways.
The development of our team members is integral to the patient care we provide. Grow your skills, and grow with Memorial.
Memorial Health System is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.