Utilization Management Director jobs in Rhode Island

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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Utilization Management Administration Coordinator
  • Humana
  • Newport, RI FULL_TIME
  • Become a part of our caring community and help us put health first
     

    Humana Healthy Horizons in Ohio is seeking a Utilization Management Administration Coordinator 2 who contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

    You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as we have grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you are working from home, from the field, from our offices, or from somewhere in between—you will feel welcome here. We are a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It is up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

    * Health Insurance begins on day one!
    * 23 days of vacation with pay per year
    * Aggressive 401K program matching 125% of 6% after year one!

    Are you caring, Curious and Committed? If so, apply today!

    The UM Administration Coordinator 2:

    • Provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members
    • Decisions are typically focus on interpretation of area/department policy and methods for completing assignments
    • Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction
    • Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion


    Use your skills to make an impact
     

    Required Qualifications

    • 1 or more years administrative or technical support experience
    • Excellent verbal and written communication skills
    • Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
    • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
    • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

    Preferred Qualifications

    • Proficient utilizing electronic medical record and documentation programs
    • Proficient and/or experience with medical terminology and/or ICD-10 codes
    • Bachelor's Degree in Business, Finance or a related field
    • Prior member service or customer service telephone experience desired
    • Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

    Additional Information

    About Humana

    Your growth is what drives Humana forward. 

    • When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we do not grow without you
    • This is a place where our nurses influence the C-suite.
    • Where software engineers change lives.
    • Where every associate can build a professional path where they learn and thrive.
    • Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
    • Because finding new ways to put health first—for our members and patients and our associates alike—is what we do. 

    Work at Home Guidance

    To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

    • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
    • Satellite, cellular and microwave connection can be used only if approved by leadership.
    • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
    • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

    Interview Format

    As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

    You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

    Scheduled Weekly Hours

    40

    Pay Range

    The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


     

    $37,200 - $51,200 per year


     

    Description of Benefits

    Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


    About Us
     

    Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


    Equal Opportunity Employer

    It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

  • Just Posted

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Nurse Reviewer / Utilization Management
  • MEDuvi LLC
  • Providence, RI FULL_TIME
  • Nurse Reviewer -Utilization Management 3-6 Month Contract / Temp to Perm ** Candidates Must have active Rhode Island Nursing License** Conduct pre and post payment review of inpatient admissions, outp...
  • 1 Month Ago

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Global Product Management Director
  • Teknor Apex Company
  • Pawtucket, RI FULL_TIME
  • Global Product Management Director Teknor Apex is a sought-after global provider of compounding solutions, our unbridled passion for technology combined with our customer-centric approach allows us to...
  • 27 Days Ago

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Director, Facilities Management
  • Snaprecruit.com
  • Smithfield, RI FULL_TIME
  • Job Title : Director Facilities Location : Smithfield, RI Duration : Permanent Hire Job Description : The ideal candidate will have: Strong technical knowledge of the following: mechanical, electrical...
  • 28 Days Ago

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Director Case Management
  • Texas Nursing Services
  • Charleston, RI FULL_TIME
  • Director Case Management 📍 Charleston, SC💼 Competitive Salary $102,107.00 - $204,069.00.| 💰 Bonus Incentives| 🌟 Sign-On Bonus: $20,000| 🚚 Relocation AssistanceOverview: Lead with passion and expe...
  • 1 Month Ago

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Facilities Management Director
  • Encompass Health
  • Johnston, RI OTHER
  • Facilities Management Director Tremendous professional abilities Truly meaningful results BE THE CONNECTION. In your role as facilities maintenance director, you'll have the opportunity to be the conn...
  • 1 Month Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$132,132 to $178,669

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