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)
Position eligible for –
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Location: Hybrid option; Available for any Partners' locations
Primary Purpose of Position:
This position is responsible for facilitating the review of service plans and service authorization requests to ensure that individuals are receiving the most appropriate services at a given time. The IDD Utilization Management Reviewer screens authorization requests for completeness, approves some requests based on an algorithm for “auto-approval” of the authorization requests, and refers requests that cannot be “auto-approved” to Licensed Utilization Management Reviewers for medical necessity review.
Knowledge, Skills and Abilities:
Education/Experience Required: A Bachelor’s Degree in a Human Services field and two (2) years of post-degree I/DD experience.
Licensure/Certification Requirements: None
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