Utilization Management Director jobs in Lowell, MA
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
- Lahey Hospital and Medical Center
-
Burlington, MA
PART_TIME
-
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Job Type:
RegularScheduled Hours:
20Work Shift:
Day (United States of America)Position Summary: Reporting directly to the Chief Medical Officer (CMO), the Physician Advisor will play an active role in optimizing healthcare resource utilization, ensuring quality, patient care, and managing valuable organizational resources. The role will involve collaborating with key stakeholders of multidisciplinary teams-Nursing staff leadership, hospitalist and closely collaborates with the director of care transitions to assess and guide the appropriate utilization of medical services while maintaining compliance with all regulatory requirements.
The Physician Advisor is responsible for assisting the organization to challenge physician practices to achieve the organization's desired resource management and quality goals.Job Description:
Purpose:
Provide leadership and expertise relative to the level of care management, concurrent and retro commercial payer validation of medical necessity recommendations, as requested
Policy Setting Responsibilities
Responsible for utilization review and medical necessity recommendations, as requested
Decision-Making Authority:
Responsible for collaborating with the utilization review department as these issues relate to commercial payers, to meet established goals and for leading physician participation and compliance with responsibilities.
Supervisory Responsibility:
Responsible for engaging physicians in utilization review and medical necessity activities
Key responsibilities:
Utilization review and inpatient clinical optimization: (include all utilization review, patient status, observation, escalation, second level and peer to peer reviews.
- Conduct thorough medical review of patient cases to determine the medical necessity of services provided.
- Assess the appropriateness of treatment plans and interventions in accordance with clinical guidelines and best practice
- Collaborate with care teams to optimize, patient care, pathways, reduce unnecessary services, and promote efficient resource allocation
- Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial payors including screening for appropriateness of hospitalization, peer –to-peer discussions with payor provider representatives, participation in the observation escalation process, clinical reviews of utilization review activities.
FLSA Status:
ExemptAs a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.
More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
Equal Opportunity Employer/Veterans/Disabled
- 1 Month Ago
- Parexel International Corporation
-
Billerica, MA
FULL_TIME
- Parexel has an exciting opportunity for an Executive Director, Portfolio Management to join our global Operational Excellence & Delivery team supporting the OED Enterprise Program Management Office. T...
- 8 Days Ago
- Parexel International Corporation
-
Billerica, MA
FULL_TIME
- The Senior Director, Strategic Resource Lead is responsible for the oversight of a team of Managers and indirect reports of individual contributors. The Senior Director is an experienced leader capabl...
- 10 Days Ago
- Parexel International Corporation
-
Billerica, MA
FULL_TIME
- Yesssssssssssssssssssssssssssss! This group is expanding, again!!!!!!If you are looking for professional advancement in PV, then this may be a great opportunity for you! This incredible opportunity co...
- 10 Days Ago
- BRIXMOR EMPLOYMENT COMPANY, LLC
-
Burlington, MA
FULL_TIME
- The Director, Property Management position reports to the Vice President, Property Management; this position is responsible to provide oversight and management of property operations, strategic initia...
- 1 Day Ago
- TRC Companies, Inc.
-
Lowell, MA
FULL_TIME
- About Us Groundbreaker. Game changer. Pioneer. TRC has long set the bar for clients who require more than just engineering, combining science with the latest technology to devise innovative solutions ...
- 1 Month Ago
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0 Utilization Management Director jobs found in Lowell, MA area
- HireMinds
-
Lexington, MA
- Director or Senior Director, Program Management (Phase II to Commercial) Location: Lexington, MA Are you a seasoned Prog...
- 4/16/2024 12:00:00 AM
- Monte Rosa Therapeutics
-
Boston, MA
- Sr. Director, Program Management Location: Boston, MA Monte Rosa Therapeutics seeks a highly motivated Program Manager l...
- 4/16/2024 12:00:00 AM
- Reimer Associates Inc.
-
Boston, MA
- Our client is a North American leader and premier provider in Healthcare Transportation and Logistics. As part of their ...
- 4/14/2024 12:00:00 AM
- Fidelity TalentSource LLC
-
Boston, MA
- Job Description: Director, Product Management The Role This role will lead product development within one of the Fidelit...
- 4/14/2024 12:00:00 AM
- Stratacuity: Proven Scientific Placement
-
Waltham, MA
- Location: Waltham, MA (Hybrid) Therapeutic Area: Immuno-Oncology Job Overview: The Senior Manager/Associate Director, Bi...
- 4/14/2024 12:00:00 AM
- Taurus Search
-
Boston, MA
- Tax Professionals Wanted! 📊💼 Are you a Tax Professional looking for a career that combines expertise with flexibility?...
- 4/12/2024 12:00:00 AM
- Lactalis US Yogurt
-
Londonderry, NH
- Job Description Job Description Lactalis US Yogurt is currently seeking candidates to join our Project Management Team. ...
- 4/12/2024 12:00:00 AM
- Argenx SE
-
Boston, MA
- PURPOSE OF THE FUNCTION At argenx, distinction is made between project teams driving asset (molecule) strategy developme...
- 4/12/2024 12:00:00 AM
About Lowell, Massachusetts
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