Utilization Management Director jobs in Texas

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 Medical Director - WellMed Medical Group
  • UnitedHealth Group
  • San Antonio, TX FULL_TIME
  • Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together. 

      

    A partner of the OptumCare network, WellMed Medical Group (WMG) is seeking a Utilization Management Medical Director to join our WellMed medical team in the San Antonio office. We are transforming healthcare nationally while providing Physician-led care locally.  Start doing your life’s best work with the largest care delivery organization in the world.

      

    The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management’s utilization management program.  The position will also provide appropriate mentoring and leadership to physicians in the market as well as develop relationships to support growth and fiscal responsibility.

      

    You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

      

    Primary Responsibilities:

    • Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
    • Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities
    • Participates in case review and medical necessity determination
    • Conducts post service reviews issued for medical necessity and benefits determination coding
    • Analyzes aggregate data and reports to primary care physician
    • Serves as the liaison between physicians and health plan Medical Directors
    • Supervises the functions of Care Coordination
    • Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area
    • Represents the providers as an influence to the credentialing committee
    • Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process
    • Educates primary care network and assists in problem resolution
    • Assists in development of medical management protocols
    • Performs analysis of utilization data and suggests/implements corrective action plans with network physicians
    • Performs all other related duties as assigned

     

    Customer Service:

    • Oversees and insures physician compliance with UM plan
    • Evaluates performance of physicians in regards to established goals and objectives of the company
    • Performs all duties with physicians and medical group staff in a professional and responsible manner
    • Responds to physicians in a prompt, pleasant and professional manner
    • Respects physician, patient, and organizational confidentiality
    • Educates medical groups regarding UM policies, procedures and government-mandated regulations
    • Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met

      

    What makes an OptumCare organization different?

    • WellMed is a Medicare Advantage Plan that operates as a health system focused on Quality/Value Based Outcomes
    • Our care model limits daily volume to allow our providers the time needed to provide quality care to their patients 
    • We offer clinical and leadership growth and stability second to none
    • Providers are supported to practice at the peak of their license
    • We are influencing change on a national scale while maintaining the culture and community of our local care organizations

      

    Compensation/Benefits Highlights:

    • OptumCare Physician Partnership Plan 
    • 401k with match, Executive Savings Plan with Match, and UHG Employee Stock Purchase Program
    • Comprehensive Benefits from Optum Partner Services  

      

    You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

    Required Qualifications: 

    • Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S
    • Active, unrestricted medical license in Texas or the ability to obtain one rapidly
    • 5 years of clinical practice experience
    • Proficiency with Microsoft Office applications

     

    Preferred Qualifications:

    • Board certification in Family or Internal Medicine
    • 2 years of experience in utilization management activities
    • 2 years of experience working in a managed care health plan environment
    • Bilingual (English/Spanish) fluency

     

    The OptumCare Story:

    At OptumCare, we’ve found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving over 14 million people through more than 38,000 aligned physicians and 9,000 advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.

     

    Would you thrive with OptumCare?

    • Do you practice evidence-based medicine?
    • Are you seeking a practice focused on patient-centered quality care, not volume?
    • Are you a team player – comfortable delegating and empowering teams?
    • Are you constantly seeking better ways to do things?
    • Do you want to be part of something better?

      

    *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

     

    California, Colorado, Connecticut, Hawaii, Nevada, New York, Rhode Island, or Washington Residents Only: The salary/hourly range for California, Colorado, Connecticut, Hawaii, Nevada, New York, Rhode Island, or Washington residents is $286,104 to $397,743. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

      

    At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

      

      

    Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

      

    UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

  • 13 Days Ago

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Utilization Management/Utilization Review
  • Windmill Wellness Ranch LLC
  • Canyon, TX FULL_TIME
  • Windmill Wellness opened the Ranch in May of 2017. We are nestled in the Texas Hill Country and are sitting on 76 acres. The mission of Windmill Wellness Ranch Is to improve the physical, spiritual an...
  • 3 Days Ago

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Utilization Management Supervisor
  • Mainstream Nonprofit Solutions Inc.
  • Dallas, TX FULL_TIME
  • Description****Average salary is $60,569.60 (including wage, incentives, bonuses, overtime, shift differential, etc.)**** Do you like working with children and families? Do you want the ability to wor...
  • 1 Day Ago

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Corporate Utilization Management Analyst
  • Oceans Healthcare
  • Plano, TX FULL_TIME
  • The Corporate Utilization Management Analyst will work collaboratively with Oceans Utilization Management Department, facility and corporate operations, and revenue cycle, to effectively track and rep...
  • 10 Days Ago

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Utilization Management Nurse
  • NeueHealth
  • Dallas, TX FULL_TIME
  • The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, mo...
  • 11 Days Ago

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LVN- Utilization Management
  • Kelsey-Seybold
  • Pearland, TX FULL_TIME
  • Responsibilities The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions ...
  • 11 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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Health Information Management Director
  • Clinical Management Consultants
  • Waterflow, NM
  • Calling all Health Information Management professionals looking to advance their career by joining an award winning hosp...
  • 3/28/2024 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

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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 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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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
  • Selby Jennings
  • Chicago, IL
  • Join a dynamic and growing team at our Client; A premier financial services firm specializing in middle-market transacti...
  • 3/24/2024 12:00:00 AM

Texas (/ˈtɛksəs/, locally /ˈtɛksɪz/; Spanish: Texas or Tejas Spanish pronunciation: [ˈtexas] (listen)) is the second largest state in the United States by both area and population. Geographically located in the South Central region of the country, Texas shares borders with the U.S. states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexican states of Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the southwest, while the Gulf of Mexico is to the southeast. Houston is the most populous city in Texas and the fourth largest in the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$124,143 to $167,864

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