Director of Utilization Management & Care Coordination

CHI; Houston (TX); On-site; USD 72,000 - 106,000; Full time

Job summary

The Utilization Management Director at Baylor St. Luke’s Medical Center (CHI St. Luke’s Health) leads market development and the UM program in alignment with the CommonSpirit Health Care Coordination model.

This role directs staff to meet or exceed performance standards and ensures efficient payer requirements management and regulatory compliance. The position oversees UM policy development, accreditation activities and continuous quality improvement, driving cost-effective, high-quality care

Qualifications

• Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
• Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination).
• 5 years of progressively responsible management experience.
• Extensive operational experience in managed care; experience in program planning, implementation, staff development, and needs assessment.
• Comprehensive knowledge of utilization management, financial management including revenue cycle, Medicare, Medicaid, and commercial admission and review requirements.

Responsibilities

• Lead market development, implementation, evaluation and direction of the Utilization Management Program and staff.
• Oversee development and implementation of UM policies, procedures and processes; ensure accreditation activities and payer compliance.
• Analyze UM program outcomes and quality metrics to improve performance.

Skills

Clinical case management

Leadership / management

Operations management

Payer requirements knowledge

Education

Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree

Job description

The Utilization Management Director at Baylor St. Luke’s Medical Center (CHI St. Luke’s Health) leads market development and the UM program in alignment with the CommonSpirit Health Care Coordination model.

This role directs staff to meet or exceed performance standards and ensures efficient payer requirements management and regulatory compliance. The position oversees UM policy development, accreditation activities and continuous quality improvement, driving cost-effective, high-quality care