Director of Utilization Management
Columbia, SC

The Director of Utilization Management works with hospital leadership to coordinate and integrate utilization management activities, using continuous quality improvement initiatives to promote positive patient outcomes. The Director of Utilization Management coordinates data collection and reporting to verify outcomes, effectiveness of utilization management activities and appropriate use of resources, to achieve appropriate length of stay and level of care, while promoting cost effective and quality patient care.  The Director of Utilization Management is responsible for planning, organizing, developing, and directing implementation of the hospital's Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, regulatory agencies, and hospital contractual payor agreements. In a dyad with the Medical Director of Utilization Management, is responsible for the quality, effectiveness, and efficiency of utilization review processes inclusive of prior authorization, concurrent and respective review, transitions of care, readmission reduction, hospital resource utilization and payer denial mitigation.

Qualifications:

• RN required
• MSN required
• Director of Utilization Management experience in an Acute Hospital setting required
• Certifications in Case Management or Utilization Management preferred
• Onsite only

Responsibilities:

• Identifies opportunities to improve patient care, health care practice and interaction with health care partners; and initiates and/or participates in development of action plans to achieve desired outcomes
• Works closely with other healthcare leaders to establish department quality indicators and to implement measures to achieve goals
• Investigates abnormal patterns of resource utilization discovered through data and outcome variances and leads improvement teams
• Serves as change agent and role model to assist in attaining established goals
• Communicates effectively throughout the Health Care System
• Educates physicians and other healthcare team members regarding denials, LOS trends
• Directs the preparation and maintenance of departmental reports
• Assists as needed with preparing reports to senior management, medical staff, board of directors and various committees.
• Keeps AVP and health care team members informed of current activities
• Maintains efficient flow of communication throughout services by keeping staff informed of organizational issues
• Will embody those behaviors, philosophy, and values which serve to uphold the ideals and enhance the image of the Health System
• Participates in hospital/medical staff committees and promotes performance improvement initiatives.
• Shares knowledge with others and promotes growth and development of others
• Attends and serves on professional/civic service organizations as hospital representative
• Responsible for own professional growth and development (minimum 50 hours educational credits annually) to keep abreast of best practices for Utilization Management
• Networks with other community providers to assure positive working relationships
• Serves as a professional role model for other staff
• Serves as patient advocate

For our Case Management opportunities, feel free to forward a resume to Michelle Boeckmann at Michelle@HCRecruiter.com or visit our Case Management website at https://www.HealthcareRecruitmentPartners.com/Careers.

If this opportunity is of interest or know someone that would have interest, please feel free to contact me at your earliest convenience.

Michelle Boeckmann | President Case Management Recruitment
Direct Dial 615-465-0292

Michelle@HCRecruiter.com
https://www.HealthcareRecruitmentPartners.com
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