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Utilization Review Care Management Director
| Company | Intermountain Healthcare |
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| Location | Las Vegas, NV, USA |
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| Salary | $66.41 – $102.52 |
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| Type | Full-Time |
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| Degrees | Master’s |
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| Experience Level | Mid Level, Senior |
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Requirements
- Master’s Degree in Nursing or Healthcare Administration. Degree must be obtained through an accredited institution. Education is verified.
- Three years of experience leading Utilization Management case management requiring knowledge of the current healthcare environment, healthcare regulatory matters and healthcare reimbursement or eight years of professional progressive experience in health care delivery.
- Hold and maintain a professional license in nursing.
- Knowledge and oversight for compliance with government regulations, contractual requirements and NCQA accreditation.
- Experience in contract negotiations.
- Experience in a role requiring strategic thinking and planning skills and the ability to develop proposals, pilots and projects from conception to implementation.
- Experience using word processing, spreadsheet, database, internet, e-mail and scheduling applications.
- Experience in a role requiring effective verbal, written and interpersonal communication skills.
Responsibilities
- Provide leadership and administrative direction for Utilization Management and Review for the Enterprise.
- Work in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders to ensure application of appropriate standards of practice, the provision of optimal patient level of care, and attainment of financial goals.
- Lead the system-wide development of partnerships with payors to support Utilization Management.
- Collaborate with Castell, Home Care, Clinic Management and Operations teams to develop strategic, operational and technology solutions to improve safety, quality, patient experience, and access, while reducing the cost of care delivered.
- Lead NCQA Utilization Management Accreditation, Survey Process, and updated annual standard review for compliance.
- Develop growth opportunities in new states setting up workflows for multimodal care management capabilities.
Preferred Qualifications
- Professional experience working in an integrated delivery system that includes a health plan.
- Experience in directing other clinical areas, working closely with physicians, and developing clinical strategies, implementing operational efforts and measuring outcomes.
- Experience evaluating technology solutions to support care management functions.
- Experience with developing collaborative relationships with payors to address healthcare needs across the continuum.
