Market Director of Utilization Management

Ascension; Nashville (TN); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Director of Utilization Management to lead strategic initiatives and optimize patient care. This pivotal role involves overseeing denial management, facilitating clinical discussions, and collaborating with various departments to enhance processes. Join a forward-thinking organization dedicated to compassionate care, where your leadership will directly impact the quality of services offered. If you're ready to innovate in a dynamic environment and drive positive change, this opportunity is for you.

Benefits

Paid time off (PTO)

Health insurance options

Retirement benefits with employer match

Long-term & short-term disability

Employee assistance programs (EAP)

Parental leave & adoption assistance

Tuition reimbursement

Community service opportunities

Qualifications

• 5+ years of experience in healthcare management required.
• Registered Nurse credential required from TN Board of Nursing.

Responsibilities

• Lead daily operations of the utilization management function.
• Oversee integration of utilization management with claims processing.
• Manage staffing activities including hiring and training.

Skills

Utilization Management

Leadership

Clinical Oversight

Root-Cause Analysis

Collaboration

Education

Bachelor's degree in Nursing

Master's degree in Nursing or related field

Job description

We Are Hiring

• Department: Utilization Management
• Schedule: Monday - Friday. 40 hours a week.
• Hospital: Ascension Saint Thomas
• Location: Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN market. Must be located with in the TN market.

We’re looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you’ll lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. You’ll collaborate with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and innovate? Apply now!

What You Will Do

Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.

• Ensure integration of utilization management functions with network strategy and claims processing.
• Oversee work with provider relations on resolving issues.
• Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions,and continuing education initiatives.
• Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to implement and manage comprehensive outpatient and inpatientutilization management programs.
• Oversee implementation and maintenance of prior authorization codes for all clients.

What You Will Need

Licensure / Certification / Registration:

• Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.

Education:

• Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.
  • Master's degree or combination of Bachelor's degree and experience preferred.

Work Experience:

• 5 years of experience required.
• 10 years of experience preferred.
• 2 years of leadership or management experience required.
• 5 years of leadership or management experience preferred.

Additional Preferences

• Utilization Management experiencepreferred.

Why Join Our Team

Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities.

Ascension is a leading non-profit, faith-based national health system made up of thousands of associates delivering compassionate, personalized care across hospitals, clinics and senior living communities.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.E-Verify

Benefits

Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer.