Utilization Review Director

Pemiscot Memorial Health Systems; Hayti (MO); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider is seeking a Utilization Review Director to oversee the UR/CM Department. This executive role requires clinical expertise and leadership skills, ensuring compliance with healthcare regulations while promoting quality improvement and positive patient relations.

Qualifications

• Minimum of 2 years of utilization review/case management discharge planning experience preferred.
• Maintain current professional licensure.

Responsibilities

• Directing all activities within the UR/CM Department.
• Developing and maintaining quality-improvement programs.
• Collaborating with physicians and medical staff.

Skills

Communication

Interpersonal Skills

Clinical Judgment

Education

Registered Nurse degree

Associate's degree in healthcare-related field

Job description

Join to apply for the Utilization Review Director role at Pemiscot Memorial Health Systems

The Director of UR/Case Management is an executive leadership position that requires clinical and leadership experience. The Director must also possess comprehensive knowledge of the healthcare industry, familiarity with CMS regulations, strategic planning skills, and understanding of the operations of a healthcare organization.

Job Description And Requirements

Responsibilities

• Responsible for directing all activities within the UR/CM Department.
• Developing and maintaining quality-improvement programs.
• Managing payroll.
• Collaborating with physicians and medical staff to ensure service expectations are met.
• Directing workflow of other case managers.
• Developing departmental policies and procedures.
• Preparing staffing plans and schedules.
• Conducting performance evaluations of employees.
• Promoting and maintaining positive relations with patients, families, and other healthcare organizations.

Qualifications

• Associate's degree in healthcare-related field preferred; Registered Nurse degree required.
• Minimum of 2 years of utilization review/case management discharge planning experience preferred.
• Maintain current professional licensure.
• Ability to interpret requests from physicians and outside sources while maintaining confidentiality.

Skills

• Excellent communication, both verbal and written, with strong interpersonal skills.
• Proficiency with computers and ability to learn new software quickly.
• Ability to apply medical criteria and clinical judgment to ensure medical necessity of admissions and treatments.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: Hospitals and Healthcare