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)
Job Description
Job Title: System Director of Utilization and Care Management
Department: Clinical Resource Management
Reports To: Senior Director, Care Transitions
Job Summary: Cayuga Health System seeks a highly motivated and goal-oriented Director of Utilization and Care Management responsible for providing oversight and broad direction to Case Management, Social Services, Utilization Management and Clinical Documentation Improvement/Integrity. The System Director of Care and Utilization Management works closely with CHS leadership - in particular Nursing, Patient Access/Accounting, Revenue Cycle, Information Systems, and Performance Optimization - to support patient progression and optimize outcomes affecting clinical, operational, and financial performance.
Job Responsibilities include:
Requirements:
Education - Masters of Nursing, Healthcare Administration, or related field required.
Experience - Minimum 5 years of experience in acute hospital setting, minimum of 3 years in leadership. Minimum 3 years of experience with utilization and denials management. Knowledge of discharge planning and clinical case management strategies. Knowledge and experience in project management and team dynamics. Outstanding leadership, analytical, negotiation and conflict resolution skill. Knowledge and experience in developing utilization management and revenue recovery strategies. Highly motivated and goal orient. Demonstrated knowledge and experience in developing utilization management and revenue recovery strategies. Demonstrated ability to implement change and lead effective teams.
Physical - Ability to stand, sit or ambulate for long periods. Ability to mobilize freely around units, transport self to site locations, and perform required data entry into EMR and alternate data management systems.
Cayuga Health System Commitment to Diversity, Equity & Inclusion
Cayuga Health System commits to treat all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.
Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees