Utilization Management Director jobs in North Carolina

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 Specialist
  • Carolina Therapeutic Services
  • Gastonia, NC FULL_TIME
  • Description

    The Utilization Management Specialist will provide general management over entire service area.  This position will serve as liaison between the Utilization Department and State Director, Therapists, and Program/Case Managers and will work closely with the Service Coordinators in order to ensure continuity of care and quality of service to consumers.  The UM will have excellent communication and documentation skills and possess an understanding of all mental health and development services.  This position plays an active part in the interdisciplinary team.  

    Requirements

     

    Responsibilities:  

    • Ensure Client Rights are being adhered by for all consumers. 
    • Responsible for attending to all the rules and regulations of the agency, state, and federal statues, and attending rules of quality improvement, medical records, finance, etc. of the agency (including delivery of service to consumers under best practice models). 
    • Monitor for quality service delivery that is in-line with best practices for delivery of services to child populations while providing consumer choice.  
    • Submit Initial and Concurrent Authorizations to MCOs for assigned contract areas 
    • Document work on all trackers (upcoming due dates, units etc.) supplied by supervisor and submit to necessary parties as required by supervisor 
    • Verify client insurance coverage for authorization submission 
    • Coordinate with MCO to resolve documents issues submitted for authorizations?? 
    • Gather all referral forms, intake forms, Screenings forms prior to submitting to MCO. 
    • Review accuracy and completion of referral forms, intake forms, Screenings forms prior to submitting to MCO.  Print all forms (the corrected version) and provide to audit personal for client’s chart 
    • Communicate with program managers when authorizations are completed, and clients are ready to be billed.  Provide program mangers electronic copy of documents needed. 
    • Tracking all new clients for completion of Screenings.  Communicate to Program/Case Managers and Therapists if not completed in timely manner 
    • Update and maintain trackers ( Referral, Master tracker) 
    • Review Screening scores for accuracy 
    • Add client demographics to Note system (update as needed) 
    • Add and update client’s goals to Note system 
    • Identify authorizations and add authorization for CALOCUS, OPT, RBHS, School Based services (update as needed) 
    • Complete/update authorization requests forms as needed 
    • Print and provide audit personal authorization for client’s charts. 
    • Complete initial and updated Beacons 
    • Identify if CALOCUS have been billed and billed on correct dates.  Will contact Lead Therapist if any issues. 
    • Requests support documentation from program?managers and therapists as needed? 
    • Report critical concerns and problems to?Supervisor?in a timely manner and actively seek Supervisor’s?input and assistance to resolving the concern.?? 
    • Reports to supervisor on a weekly basis 

    What you get:

    Competitive Wages

    Health Benefits 

    Paid Time Off

    Employee Assistance Plan (dependents eligible)

  • 1 Day Ago

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Utilization Management Coordinator
  • Children's Hope Alliance
  • UNKNOWN, NC OTHER
  • Description: Summary The Utilization Management Coordinator provides support by coordinating the submission of initial and concurrent authorizations for assigned program areas with the goal of ensurin...
  • 3 Days Ago

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Registered Nurse, Utilization Management
  • Med4Hire
  • Arden, NC CONTRACTOR,TEMPORARY,PART_TIME
  • POSITION TYPE: Registered Nurse (RN) - NEW GRADSSPECIALTY UNIT: Intensive Care Unit - ICU, Medical/Surgical – Med/SurgLOCATION: Arden ,CTSHIFT: (3p-11:30p X3) - crisis compliance approvedJOB TYPE: Con...
  • 7 Days Ago

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Utilization Management Rep III
  • elevancehealth
  • Cary, NC FULL_TIME
  • Job ID: JP00044128Anticipated Start Date: 12/18/23Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.Elevance Health is a...
  • 27 Days Ago

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IDD Utilization Management Supervisor (Hybrid Option)
  • Partners Health Management
  • Elkin, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 25 Days Ago

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IDD Utilization Management Supervisor (Hybrid Option)
  • Partners Health Management
  • Statesville, NC FULL_TIME
  • Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and si...
  • 25 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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Managing Director
  • Chapman Associates, Inc.
  • Chapman Associates is a Mergers & Acquisitions association focused on middle-market strategic acquisitions on the buy an...
  • 3/28/2024 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)....
  • 3/28/2024 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
  • 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 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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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

North Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the southeastern region of the United States. It borders South Carolina and Georgia to the south, Tennessee to the west, Virginia to the north, and the Atlantic Ocean to the east. North Carolina is the 28th-most extensive and the 9th-most populous of the U.S. states. The state is divided into 100 counties. The capital is Raleigh, which along with Durham and Chapel Hill is home to the largest research park in the United States (Research Triangle Park). The most populous municipality is Charlotte, which is the second-largest banking center in...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$121,238 to $163,936

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