Utilization Management Director jobs in Nebraska
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)
Recently Added Utilization Management Director jobs
- CHI Health Immanuel
-
OMAHA, NE
PART_TIME
-
Overview
Our Utilization Management Assistant receives, processes, facilitates and documents all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers.
Responsibilities- Receives, sends and documents payer requests for clinical documentation.
- Receives and documents payer authorization and communications including but not limited to concurrent denials.
- Coordination of peer to peer conversations, as applicable.
- Reviews surgery schedule to verify correct authorization is documented, if applicable.
- Identifies accounts lacking authorization and follows up with payers, as needed.
- Communicates with interdepartmental staff regarding payer documentation requests.
- Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
- Identifies and reports trends to department Leadership.
- Utilizes payer related reports from Care Management software, where applicable.
- Collaborates with and supports the UM team including but not limited to UR and Denials RN.
- Contributes to the identification of opportunities for process improvement.
- Supports administrative departmental functions, as assigned.
- Other job duties as assigned.
QualificationsRequired Education and Experience
Required
● Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience
● High school diploma or GED required
Preferred
● An understanding of operations and functions of care coordination, utilization management, denials mitigation is preferred.
- 29 Days Ago
- Elevance Health
-
Lincoln, NE
FULL_TIME
- Job Family: CUS > Care Support Type: Full time Date Posted: Apr 22, 2024 Anticipated End Date: Apr 28, 2024 Reference: JR113349 Description A proud member of the Elevance Health family of companies, C...
- 1 Day Ago
- Mendota Health
-
Omaha, NE
FULL_TIME
- THIS IS A HYBRID POSITION. TRAVEL IS REQUIRED. Mendota Health is a leading provider of mobile wound care services. We specialize in helping patients heal their wounds by providing the best possible tr...
- Just Posted
- NEBRASKA LIFESTYLES LLC
-
Omaha, NE
FULL_TIME
- Must have extensive experience in Property Management at a high level. Regional Managers or Operations Managers are encouraged to apply.We are a fast-growing property management company specializing i...
- 30 Days Ago
- HERITAGE MANAGEMENT SERVICES INC
-
Omaha, NE
FULL_TIME
- Our Executive Director Will: Lead and grow all aspects of our local operations.Build strong relationships in a positive environment throughout the community.Coach and develop associates as leaders and...
- 19 Days Ago
- HERITAGE MANAGEMENT SERVICES INC
-
Omaha, NE
FULL_TIME
- Fountain View by Heritage Communities is Hiring! Our Director of Sales Will: Organize personal tours, events, and private meetings to collaborate with individuals and families to understand and meet t...
- 1 Day Ago
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-
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- Hunt Mh Shared Services Llc
-
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-
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- Encompass Health
-
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