Utilization Management Director jobs in Alaska

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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System Director of Utilization Review
  • Southeast Alaska Regional Health Consortium
  • Juneau, AK FULL_TIME
  • Pay Range:
    $47.91 - $61.29
    SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
    Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.
    This position oversees the coordination of inpatient care services including Utilization Review, Case Management/Discharge Planning, and Social Services. This position develops and integrates strategies to enhance the quality of care for patient satisfaction, and healthcare outcomes.

    At MEMC, this position could include a grant-funded Psychiatric Emergency Services (PES) program.
    Key Essential Functions and Accountabilities of the Job
    • Responsible for directing a system-wide utilization review process, including Case Management and Social Services, in multiple locations.
    • Must be able to understand and manipulate advanced systems and work with and synthesize large relational data sets, providing descriptive/predictive/prescriptive analytics to support operational behavior modification.
    • Meet and exceed department service, operational and financial goals, provide analysis, identification of variances and develop action plans to achieve established goals. Report unit performance to internal stakeholders as required.
    • This position works intensively with advanced systems to track and trend denials, builds models for documentation improvement plans, and coordinates with all areas and levels of Southeast Alaska Regional Health Consortium (“SEARHC”) Hospitals.
    • Work closely with revenue cycle and other finance staff to maximize revenues while maintaining compliance with regulations affecting utilization management. The position requires close interaction with and knowledge of the Medicare and Medicaid programs and other third-party payers.
    • This position works closely with the provider community to improve clinical documentation and with administration to ensure appropriate hospital resource use. Care coordination includes the internal collaboration with the SEARHC Primary Care Clinics and Long-Term Care facilities. External collaboration includes tertiary care, assisted living, and psychiatric facilities.
    • Direct the Utilization Review Department and ensure safe, efficient, and effective utilization of hospital facilities and services.
    • Maintain compliance with all regulations.
    • Participate in the development and implementation of departmental policies and procedures, and monitor/ensure compliance and consistency.
    • Review and revise workflows and procedures to ensure maximization of resources and excellence in customer service.
    • Chair the Utilization Review Committee. Coordinate and attend all Quarterly Utilization Review meetings and provide information and data relative to the review process and any identified problems.
    • Works collaboratively with Physician Advisor and provider teams to ensure the appropriateness and necessity of an individual’s admission to or continued stay in hospital.
    • Monitor quality measures, collecting and analyzing data to improve utilization of services and the effectiveness and appropriateness of support services.
    • Oversee and support the psychiatric emergency service clinicians who assist the Emergency and Inpatient departments in patient assessments and recommendations to care team.
    • Ensure timely and appropriate maintenance of records, with documentation of services provided and progress consistent with the care plan.
    Education, Certifications, and Licenses Required
    • Bachelor’s degree from an accredited school required.
    • Higher level of education preferred.
    • Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required. Direct Hire must have applied for an Alaska nursing license before start date. Agency staff must have an active Alaska license.
    • High school diploma or equivalent required.
    Experience Required
    • Prior experience in the utilization and review function required.
    • Previous management experience in supervision or administration required.
    • Prior experience working in a Critical Access Hospital model preferred.
    • Five years of clinical experience preferred.
    • Prior experience in Performance Improvement preferred.
    Knowledge of
    • Knowledge of health care service delivery systems and third-party reimbursement; knowledge of managed care environment.
    • Solid understanding of healthcare, federal, and state regulations.
    • Understanding of admission and discharge functions.
    • Familiarity with medical terminology, diagnostic terms, and treatment modalities.
    Skills in
    • Strong interpersonal, organizational, evaluative, and time management skills.
    • Policy interpretation skills; familiarity with applicable standards and regulations.
    • Provider communication and behavior change can be challenging; this individual must be an expert communicator and change agent.
    • Responsiveness to deadlines; assertiveness, persistence, and persuasiveness.
    Ability to
    • Ability to apply and interpret admission and continued stay criteria.
    • Ability to organize tasks related to the accomplishment of hospital goals and objectives.
    • Ability to work in a professional manner with physicians, outside agencies, and support staff.
    • Ability to travel to multiple locations.
    Required Certifications:
    Registered Nurse License - State of Alaska - Alaska State Board of Nursing
    If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
  • 3 Days Ago

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Insurance Verifications Representative - Utilization Management Department - Closes: 12/12/2022
  • Alaska Native Tribal Health Consortium
  • Anchorage, AK FULL_TIME
  • The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partners...
  • 24 Days Ago

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Director of Digital Product Management
  • Arrow Electronics
  • Alaska, AK FULL_TIME
  • Description Arrow Electronics is a global provider of products, services, and solutions to industrial and commercial users of electronic components and enterprise computing solutions. Arrow Electronic...
  • 1 Day Ago

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Assistant Director Talent Management
  • Anchorage School District
  • Anchorage, AK FULL_TIME
  • JobID: 12725 Position Type: Classified Administration/Assistant Director Talent Management Date Posted: 8/2/2022 Location: TALENT MANAGEMENT Bargaining Unit: EXEMPT Work Year: 12 months Work Day: 8 ho...
  • 8 Days Ago

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Director of Technology Systems Management
  • Potawatomi Federal Solutions - PFS
  • Anchorage, AK FULL_TIME
  • Position Title: Director of Technology Systems Management Division: PFS Location: Remote Manager: General Manager (GM) of PFS; dotted line reporting to SVP, Ops EEO Class: Professional FLSA Classifica...
  • 1 Month Ago

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Affordable Community Director - Non-Exempt - REF3304Y
  • FPI Management
  • Juneau, AK FULL_TIME
  • Company Description Multifamily Property Management The Community Director (Non-Exempt) is fully accountable for all day-to-day operations of a typically small asset/property (totaling less than 300 u...
  • 22 Days Ago

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Managing Director, Practice Management - Private Equity
  • Goodwin Procter LLP
  • Boston, MA
  • Make an impact at Goodwin, where we partner with our clients to practice law with integrity, ingenuity, agility and ambi...
  • 3/29/2024 12:00:00 AM

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Operational Risk Management Director -- Issues Management
  • MUFG (DBA)
  • New York, NY
  • Do you want your voice heard and your actions to count? Discover your opportunity with Mitsubishi UFJ Financial Group (M...
  • 3/29/2024 12:00:00 AM

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Managing Director
  • SpartaCraft
  • Connelly Springs, NC
  • Job Description Job Description SpartaCraft, a contract wood products and finishing company in Connelly Springs, NC is l...
  • 3/28/2024 12:00:00 AM

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Health Information Management Director
  • Clinical Management Consultants
  • Waterflow, NM
  • Calling all Health Information Management professionals looking to advance their career by joining an award winning hosp...
  • 3/28/2024 12:00:00 AM

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Managing Director, Product Management
  • Omnicom Media Group
  • New York, NY
  • Overview Job Description Annalect's 2,000+ innovators leverage data and technology to help clients across Omnicom build ...
  • 3/27/2024 12:00:00 AM

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Case Management Director
  • Clinical Management Consultants
  • Plainview, TX
  • An award winning medical center is searching for a strong, experienced Case Management Director. Our team is excited to ...
  • 3/25/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 3/25/2024 12:00:00 AM

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Managing Director
  • Transamerica Premier Life Insurance Company
  • Nashville, TN
  • The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
  • 3/25/2024 12:00:00 AM

Alaska is the northernmost and westernmost state in the United States and has the most easterly longitude in the United States because the Aleutian Islands extend into the Eastern Hemisphere. Alaska is the only non-contiguous U.S. state on continental North America; about 500 miles (800 km) of British Columbia (Canada) separates Alaska from Washington. It is technically part of the continental U.S., but is sometimes not included in colloquial use; Alaska is not part of the contiguous U.S., often called "the Lower 48". The capital city, Juneau, is situated on the mainland of the North American ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$137,782 to $186,306

Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
February 09, 2020
Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
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Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019