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)
Applicants must live in Volusia or Flagler Counties to be Considered.
UM department functions 7 days/wk, 365 days/year with a 24/7 on-call nurse. Weekend/holiday rotations and on-call rotations may be required. We currently have nurses working about once every 6-8 weekends.
POSITION SUMMARY:
Under the direction and oversight of the Nurse Supervisor Utilization Management, the Inpatient Utilization Review Nurse is responsible for coordination of services for members of Florida Healthcare Plans admitted to and/or discharged from an inpatient acute or skilled nursing facility as well as outpatient services as delegated. The Inpatient Utilization Review Nurse coordinates all systems/services needed for an organized, multidisciplinary, member focused team approach. The Inpatient Utilization Review Nurse follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers, and other staff from outside as well as within the company to ensure quality care and safe outcomes. The Inpatient Utilization Review Nurse conducts initial and ongoing assessments and ensures continuity of care through discharge planning and utilization of resources. Care should be approached in a cost-effective manner as this position bears risk for financial impact to the organization.
QUALIFICATIONS:
Education, skills, and experience: