Utilization Management Director

Hamaspik Choice; Village of Spring Valley (NY); Sur place; USD 130 000 - 150 000; Plein temps

Résumé du poste

Hamaspik Choice is seeking a Director of Utilization Management (RN) to lead the Utilization Management Department in a full-time role.

The candidate will oversee the U/M staff, ensure CMS and DOH compliance, and develop policies and processes that optimize care coordination and resource use. NYS RN license is required, with 3+ years in a senior management position.

Qualifications

• 3+ years in a senior management role in utilization management.
• Utilization Management experience required.
• NYS licensed RN required.

Responsabilités

• Provide day-to-day oversight of Utilization Management operations and ensure alignment with management.
• Develop utilization management policies consistent with Medicare requirements.
• Lead reviews of CMS, InterQual, and DOH guidelines and update workflows as needed.
• Provide leadership for utilization management policy initiatives and program improvements.
• Develop processes and training for the Utilization Review team and monitor compliance.
• Direct staff in case management, pre-certification, and utilization review to meet objectives.

Connaissances

Utilization Management

Senior management

Policy development

CMS guidelines

DOH guidelines

Formation

NYS RN license

4 Year Degree

Description du poste

• Location 775 North Main Street,Spring Valley, NY, 10977,United States
• Base Pay $130,000.00 - $150,000.00 / Year
• Employee Type Full Time
• Required Degree 4 Year Degree

Description

Job Overview:

The Director of Utilization Management (RN) develops, oversees, and directs the Utilization Management Department. Candidate leads and directs the utilization review staff and program while promoting the success of Utilization Management functions through care coordination. Additionally, determines policies and procedures that incorporate best practices and ensures effective utilization reviews.

• Provides day-to-day oversight of Utilization Management operations, ensuring all practices and programs are aligned with the management team, directs the policies and procedures, and standards for utilization management operations.
• Develops utilization management policies, consistent with all Medicare requirements
• Reviews CMS, InterQual, and DOH guidelines to determine if updates are needed for Utilization Management department and workflows
• Provides leadership utilization management policy initiatives and Implement modifications and improvements to existing programs as needed.
• Develops processes, trainings, and protocols for the Utilizations Review team
• Ensures compliance, timeliness, and completeness of Care Plans
• Training of new hires, ongoing re-training of staff
• Prepares agenda and leads team regularly scheduled meetings
• Monitors utilization reports, identifying changes in utilization and overall trends
• Documents case review findings, actions, and outcomes in accordance with Utilization Management policies
• Manages the development and implementation of effective utilization management strategies.
• Directs the efforts of the utilization review, case management, and pre- certification functions to accomplish objectives within policy and budget.
• Performs all assigned tasks and projects
• Determines staff needed to support U/M and appeals processes

Required Education, Experience, and Licenses:

• 3+ years’ experience in a senior management role.
• Utilization Management experience required.
• NYS licensed RN.