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)
SUMMARY: This position will actively and retrospectively review medical cases to confirm that patient receive appropriate care and ensures cost effectiveness of health care services. Utilization management relates to all components in the health care system including primary, specialty and inpatient settings.
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UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES: The Composite Health Care System (CHCS), MHS GENESIS, Armed Forces Health Longitudinal Technology Application (AHLTA), and ICD-B programs must be utilized for referral management services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide system accounts for MSS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service processes moves away from specified systems, the government will modify the task order accordingly.
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WORK ENVIRONMENT/PHYSICAL REQUIREMENTS: The work can be sedentary. However, there may be some physical demands. Requirements include standing, sitting or bending. Individual will be required to walk throughout facility to pick up family practice clinic, medical records, and radiology mail drop offs/signed referrals.
Job Type: Full-time
Salary: Up to $37.52 per hour
Work Location: In person
Job Type: Full-time
Pay: $37.52 per hour
Expected hours: 40 per week
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Work Location: In person
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