Utilization Management Director jobs in Owensboro, KY

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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Case Management Specialist - Utilization Review
  • Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary

    Job Summary

    Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and providing guidance, education, and support to assigned patients.
     
    Job Responsibilities
    • Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
    • Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
    • Provides appropriate clinical information to payers as requested within specified time frame.
    • Collaborates with the Physician, Medical Director, Director, Manager, and Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization.
    • Delivers regulatory letters to patients as needed.
    • Provides education and acts as a resource for physicians, staff, and patients/families regarding utilization review processes.
    • Trains new case managers, students, and interns as needed.
    Qualifications
    • Associate's degree or higher in Nursing required upon hire AND
    • Bachelor's degree or higher in Nursing required within 5 years of employment in this position
    • No experience required
    • RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire
    Skills and Attributes
    • Requires critical thinking skills and decisive judgment.
    • Works under minimal supervision.
    • Must be able to work in a stressful environment and take appropriate action.
    Physical Demands
    • Standing: Occasionally
    • Walking: Occasionally
    • Sitting: Frequently
    • Lifting 0-25 lbs: Rarely
    • Lifting 25-75 lbs: Never
    • Lifting over 75 lbs: Never
    • Carrying 0-25 lbs: Rarely
    • Carrying 25-75 lbs: Never
    • Carrying over 75 lbs: Never
    • Pushing/Pulling 0-25 lbs: Rarely
    • Pushing/Pulling 25-75 lbs: Never
    • Pushing/Pulling over 75 lbs: Never
    • Climbing: Rarely
    • Bending/Stooping: Rarely
    • Kneeling: Rarely
    • Crouching/Crawling: Rarely
    • Reaching: Occasionally
    • Talking: Frequently
    • Hearing: Occasionally
    • Repetitive Foot/Leg Movements: Never
    • Repetitive Hand/Arm Movements: Frequently
    • Keyboard Data Entry: Frequently
    • Running: Never
    • Vision: Depth Perception: Frequently
    • Vision: Distinguish Color: Frequently
    • Vision: Seeing Far: Frequently
    • Vision: Seeing Near: Frequently
    Owensboro Health Core Commitments

    INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

    RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

    TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

    INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

    SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

    EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.
  • 1 Month Ago

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Utilization Management Specialist - Carbondale, IL
  • Gateway Foundation, Inc.
  • Carbondale, IL FULL_TIME
  • Utilization Management Specialist - Carbondale, IL Post Date: Mar 20, 2024 Location: Carbondale, IL, US, 62901 Position Type: Full Time Requisition Number: 31696 Work Schedule: Monday - Friday Are you...
  • 1 Month Ago

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Director of Nursing
  • ClearView Healthcare Management
  • Owensboro, KY FULL_TIME
  • Long Term Care Facility is seeking a Director of Nursing! Responsibilities Direct, oversee and evaluate all nursing personnel (registered nurses, LPN etc.) Guide staffing procedures Set objectives and...
  • 10 Days Ago

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Director Of Nursing
  • Infinity Healthcare Management
  • Rockport, IN FULL_TIME
  • NOW HIRING - Director of Nursing (DON)/Registered Nurse (RN) New Wages We are looking for ambitious and energetic talent to join our Team!! The Director of Nursing leads and directs the overall clinic...
  • 28 Days Ago

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Assistant Director of Nursing
  • Infinity Healthcare Management
  • Rockport, IN FULL_TIME
  • WE ARE LOOKING FOR AN ASSISTANT DIRECTOR OF NURSING TO JOIN OUR TEAM! JOB SUMMARY:Support the Director of Nursing in planning, developing, organizing, directing and evaluating services and activities ...
  • 9 Days Ago

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Director of Quality Risk Management and Compliance
  • Brentwood Springs
  • Newburgh, IN FULL_TIME
  • Overview Director of Quality, Compliance, and Risk Brentwood Springs is a 48-bed behavioral hospital located in Newburgh, IN. The hospital offers inpatient and outpatient mental health and addiction t...
  • 21 Days Ago

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0 Utilization Management Director jobs found in Owensboro, KY area

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Local Coordinator for High School foreign Exchange Student Program
  • Greenheart Exchange
  • Evansville, IN
  • Job Description Job Description By becoming a Greenheart Exchange Local Coordinator, you have the opportunity to change ...
  • 4/26/2024 12:00:00 AM

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Legal Admin Specialist (Estate & Gift Tax) (Estate Tax Technical Advisor) (TEMP NTE 1 YR MBE, MBP)
  • Department Of The Treasury
  • Owensboro, KY
  • Duties WHAT IS THE SMALL BUSINESS SELF EMPLOYED (SBSE)DIVISION? A description of the business units can be found at: htt...
  • 4/26/2024 12:00:00 AM

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General Manager
  • PSC Industries, Inc.
  • Evansville, IN
  • Job Description Job Description PSC Industries www.pscindustries.com General Manager Evansville, IN – Full Time Job Summ...
  • 4/25/2024 12:00:00 AM

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Assistant Project Manager - 3107
  • Barnhart Crane & Rigging
  • Owensboro, KY
  • PURPOSE – Barnhart is built on a strong foundation of serving others. The fruit of our labor is used to grow the company...
  • 4/24/2024 12:00:00 AM

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Case Management Specialist - Utilization Review - No Experience Required
  • Owensboro Medical Health System
  • Owensboro, KY
  • Job Summary Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and provid...
  • 4/24/2024 12:00:00 AM

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Middle Office Manager
  • Old National Bank
  • Evansville, IN
  • Overview: Old National Bank has been serving clients and communities since 1834. With $48 billion in total assets, we ar...
  • 4/24/2024 12:00:00 AM

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Executive Director - LNHA
  • Woodmont Health Campus
  • Boonville, IN
  • JOIN TEAM TRILOGY: Our Executive Directors/Nursing Home Administrators love Trilogy for the stability, meaningful work, ...
  • 4/22/2024 12:00:00 AM

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System Director of Case Management
  • Deaconess Health System
  • Evansville, IN
  • Join Our Team# We are looking for compassionate, caring, and dedicated System Director of Case Management to join our te...
  • 4/22/2024 12:00:00 AM

Owensboro is a home rule-class city in and the county seat of Daviess County, Kentucky, United States. It is the fourth-largest city in the state by population. Owensboro is located on U.S. Route 60 about 107 miles (172 km) southwest of Louisville, and is the principal city of the Owensboro metropolitan area. The 2015 population was 59,042.[not in citation given] The metropolitan population was estimated at 116,506. Owensboro is located at 37°45′28″N 87°7′6″W / 37.75778°N 87.11833°W / 37.75778; -87.11833 (37.757748, −87.118390), at the crook of a bend in the Ohio River. Owensboro is 37 mile...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$119,223 to $161,213
Owensboro, Kentucky area prices
were up 1.3% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020