Utilization Review Care Management Director

Jobtailor

Ogden (UT)

On-site

USD 120,000 - 160,000

Full time

4 days ago

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Job summary

Jobtailor in Utah seeks a senior leader to provide leadership and administrative oversight for coordination of patient services across multidisciplinary teams and the continuum of care. Travel to locations across the enterprise as required.

You will collaborate with Medical Staff, Nursing, Clinical Services, and Revenue Cycle leadership to promote high-quality care, financial objectives, and leadership development, while overseeing complex care management, transition planning, and compliance

Qualifications

Current RN license or LCSW license in state of practice.
BSN or MSW from an accredited institution; degree verification required.
Care Management Certification within 24 months of hire/promo.
Demonstrated management experience in Care Management or related area.
Experience with hospital or ambulatory case management, social work, or related areas.

Responsibilities

Provide leadership and administrative oversight for coordination of patient services across multidisciplinary teams and the continuum of care.
Collaborate with Medical Staff, Nursing, Clinical Services, and Revenue Cycle leadership to promote high-quality care, financial objectives, and leadership development.
Oversee complex care management, social work, transition planning, behavioral health, and care coordination services.
Design, implement, and manage longitudinal care strategies for seamless transitions across care settings.
Lead initiatives to optimize health outcomes and cost-effectiveness; travel to locations across the enterprise as required.

Skills

Care Management

Complex Care Management

Behavioral Health Oversight

Budget Management

Performance Monitoring

Strategic Planning

Regulatory Compliance

Leadership

Collaboration

Healthcare Reimbursement Knowledge

Education

BSN

MSW

MSN

Care Management Certification

Tools

NCQA Standards

Job description

Provide leadership and administrative oversight for coordination of patient services across multidisciplinary teams and the continuum of care
Collaborate with Medical Staff, Nursing, Clinical Services, and Revenue Cycle leadership to promote high-quality care, financial objectives, and leadership development
Oversee complex care management, social work, transition planning, behavioral health, and care coordination services
Design, implement, and manage longitudinal care strategies for seamless transitions across care settings
Lead initiatives and partnerships to optimize health outcomes and cost-effectiveness
Travel to locations across the enterprise as required
Oversee strategic planning, day-to-day operations, standards of care, and fiscally responsible care delivery
Manage budgets, cost centers, and ongoing fiscal performance monitoring
Lead workforce planning, recruitment, retention, staffing, development, and succession planning
Oversee interviewing, hiring, onboarding, training, performance management, corrective action, and termination
Facilitate coordinated clinical and non-clinical care with interdisciplinary teams and providers
Partner with physicians to achieve clinical, operational, financial, and service excellence
Ensure patient satisfaction and service quality goals are supported
Build community relationships and integrate community resources
Ensure compliance with regulatory requirements for discharge planning, conditions of participation, and care management

Requirements

Current Registered Nurse (RN) license or Licensed Clinical Social Worker (LCSW) license in state of practice
Bachelor of Science in Nursing (BSN) OR Master of Social Work (MSW) from an accredited institution; degree verification required
Care Management Certification within 24 months of hire or promotion
Demonstrated management experience in Care Management or related area
Demonstrated experience in hospital or ambulatory case management, social work, or related areas requiring knowledge of the current healthcare environment, healthcare regulatory matters, and healthcare reimbursement
Demonstrated knowledge and oversight of government regulations, contractual requirements, and NCQA accreditation standards
If an RN, Master of Science in Nursing (MSN) from an accredited institution must be obtained within four (4) years of hire or promotion (preferred qualification)
Professional experience working in an integrated delivery system that includes a health plan (preferred)
Experience directing other clinical areas, collaborating with physicians, developing clinical strategies, implementing operational efforts, and measuring outcomes (preferred)
Experience evaluating technology solutions to support care management functions (preferred)
Experience developing collaborative relationships with payors to address healthcare needs across the continuum (preferred)
Experience requiring strategic thinking and planning skills and developing proposals, pilots, and projects from conception to implementation (preferred)
Ability to meet stated physical requirements, including reading information, communicating verbally, hearing, manual dexterity, and frequent computer use
For roles requiring driving, ability to drive a vehicle

Core Competencies

Demonstrates expertise in care management, including oversight of multidisciplinary teams, strategic planning, and compliance with healthcare regulations. Proven ability to lead initiatives that enhance patient outcomes and optimize operational efficiency.

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