Utilization Management Director jobs in Idaho
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)
Recently Added Utilization Management Director jobs
Utilization Management Team Leader
- PacificSource
-
Boise, ID
FULL_TIME
- Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Manage the services, functions and personnel, including accountability for operational aspects and delegation of duties to the Health Service Representatives (HSRs). Responsible for hiring, training, coaching, counseling, and evaluating team members’ performance. Coordinate application of services and benefits. Handle Medical Services-related inquiries and communicate benefit determinations. Act as a liaison and information resource to internal and external customers. Essential Responsibilities: Compile and manage Health Services (HS) statistics related to PRISM, regulatory requirements and other monthly reports. Analyze medical services utilization data to formulate recommendations for maintaining and improving the delivery of services to our members and providers. Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones, regular audits and performance evaluations, for direct reports. Identify ongoing training needs for Health Services Representatives. Assist HS Medicaid HSR trainer. Review new hire training plan and progress Accountable for ensuring exceptional customer service via the Health Services phone queue. Ensure related metrics are consistently met. Track and trend member and provider complaints. Ensure appropriate follow up. Formulate recommendations for improved service delivery and escalate/implement as indicated. Work collaboratively with Health Services Manager to maintain and develop departmental communication materials (i.e. letters, forms), training/educational material as well as policies and procedures. Actively participate in and assist with efforts to support compliance and regulatory requirements across lines of business. Participate in regular audits. Work collaboratively with the communication team to ensure external material is approved. Help to troubleshoot and resolve issues related to Health Services, escalating when appropriate. Ensure all coverage determinations are processed in a timely and accurate manner. Provide support and maintenance for department communication tools. (i.e. SharePoint) Coordinate business activities by maintaining collaborative partnerships with key departments. Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards to monitor key performance indicators and identify improvement opportunities. Actively participate as a key team member in department, leadership and team meetings. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy. Conduct regular team meetings and one-on-one meetings with the Health Service Representatives on the Health Services team. Supporting Responsibilities: Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Meet department and company performance and attendance expectations. Perform other duties as assigned. Work Experience: Three years of health insurance or healthcare experience required. Two years working as a Health Services Representative preferred. Previous leadership or supervisory experience preferred. Intimate familiarity with Medicaid terminology preferred. Education, Certificates, Licenses: Minimum high school diploma or equivalent required. Knowledge: Medical terminology, Health Insurance industry. Strong computer skills and typing. Microsoft Excel, Outlook, and Word. Proficiency in Facets and Case Trakker Dynamo and ShoreTel. Requires ability to define and prioritize problems and manage workload without direct supervision. Competencies: Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our 1,900 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance April 16: Central Oregon Community College Job Fes, 10a-1p (2600 NW College Way, Bend, OR 97703) April 17: Oregon State Spring Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) April 18: University of Oregon Spring Career Fair, 12p-4p at the EMU Ballroom (1395 University St, Eugene OR 97403) April 24: Linn Benton Community College Career Fair, 10a-2p (6500 Pacific Blvd SW, Albany OR 97321) May 14: Idaho Business League, 10a-2p at Courtyard by Marriot (1789 S Eagle Road, Meridian ID) PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2023 alone we had 407 internal promotions! Top Workplace 2024 USA | USA Today Certified Age Friendly Employer, 2023 | Age Friendly Institute Top Workplace 2023 and 2022 for Idaho | Idaho Press Top Workplace 2023 and 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HRrecruiting@PacificSource.com.
- 1 Day Ago
Post Acute Care Utilization Management Advisor
- St. Luke's Health System
-
Boise, ID
FULL_TIME
- Overview St. Luke’s Health System is seeking a Post-Acute Care Advisor to join our Health Partners team. This role offers a variety of flexibility including the ability to work remotely (within health...
- 1 Month Ago
Case Management- Utilization Review/CDI-(FT)
- Madison Memorial Hospital
-
Rexburg, ID
FULL_TIME
- The Clinical Documentation Specialist/Utilization Review RN is responsible for the evaluation of physician documentation utilizing their clinical expertise to support excellence in documentation and e...
- 25 Days Ago
Case Management- Utilization Review/CDI-(FT)
- Madisonhealth
-
Rexburg, ID
FULL_TIME
- Case Management- Utilization Review/CDI-(FT) The Clinical Documentation Specialist/Utilization Review RN is responsible for the evaluation of physician documentation utilizing their clinical expertise...
- 28 Days Ago
Director of Quality Management
- Clinical Management Consultants
-
Ashton, ID
FULL_TIME
- An Accredited Medical Center just to the West of the Teton Valley has just announced an exciting opportunity for an experienced Director to join their Quality Department and help to ensure high qualit...
- 12 Days Ago
Hospital Quality Management Director
- Clinical Management Consultants
-
Ashton, ID
FULL_TIME
- An Accredited Medical Center just to the West of the Teton Valley has just announced an exciting opportunity for an experienced Director to join their Quality Department and help to ensure high qualit...
- 27 Days Ago
Utilization Management Director jobs at Popular Companies
Managing Director, Conflict Management & Dispute Resolution
- Dallas College
-
Dallas, TX
- Position Summary The Managing Director of Conflict Management & Dispute Resolution will be responsible for effectively d...
- 4/18/2024 12:00:00 AM
Facilities Management Director
- Encompass Health
-
Mcdonough, GA
- The Facilities Management Director is responsible for ensuring that the company Rehabilitation Hospital, satellite clini...
- 4/18/2024 12:00:00 AM
Utility Management Director
- Hunt
-
Honolulu, HI
- A Brief Overview The Utility Management Director is responsible for providing leadership, direction and guidance as it p...
- 4/16/2024 12:00:00 AM
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 ...
- 4/16/2024 12:00:00 AM
Facilities Management Director
- Encompass Health
-
Altoona, PA
- The Facilities Management Director is responsible for ensuring that the company Rehabilitation Hospital, satellite clini...
- 4/15/2024 12:00:00 AM
Associate Program Management Director/Program Management Director
- MacroGenics, Inc.
-
Rockville, MD
- MacroGenics is a leader in the discovery and development of innovative medicines that utilize our next generation antibo...
- 4/15/2024 12:00:00 AM
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 ...
- 4/14/2024 12:00:00 AM
Managing Director
- Transamerica Premier Life Insurance Company
-
Columbia, SC
- The Managing Director is responsible for growing the business of the District Office by developing new quality sales, co...
- 4/14/2024 12:00:00 AM
About Idaho
Idaho (/ˈaɪdəhoʊ/ (listen)) is a state in the northwestern region of the United States. It borders the state of Montana to the east and northeast, Wyoming to the east, Nevada and Utah to the south, and Washington and Oregon to the west. To the north, it shares a small portion of the Canadian border with the province of British Columbia. With a population of approximately 1.7 million and an area of 83,569 square miles (216,440 km2), Idaho is the 14th largest, the 12th least populous and the 7th least densely populated of the 50 U.S. states. The state's capital and largest city is Boise.
Idaho p...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$118,084 to $159,673
Most Popular Cities in Idaho for Utilization Management Director Jobs
What does a Utilization Management Director do?
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.
February 18, 2020
Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019