Utilization Management Director jobs in Virginia
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
- Sentara
-
Norfolk, VA
FULL_TIME
-
Sentara Healthcare is seeking to hire a qualified individual to join our team as a Director, Utilization Management.
Position Status: Full-time, Day Shift
Position Location: This position is remote within our remote states.
Standard Working Hours: 8:00AM to 5:00PM (ET).
Minimum Requirements:
- Bachelor’s degree required.
- Single state RN (based on remote state) required.
- 5 years leadership experience required.
Preferred Requirements:
- Master’s degree preferred.
Expectations for this Role:
Sentara Health Plans is seeking a Director, Utilization Management supporting and facilitates continuous efforts to improve organizational and clinical performance, ensuring quality of care meets or exceeds regulatory standards and requirements as measured by division quality leaders.
Additional Expectations:
- Compliance.
- Staff retention.
- Strategy.
- Cost Effectiveness.
- Accountability.
This role will have 4 direct managers and managers will have 2 team coordinators under them.
Sentara Health Overview
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).
Mission, Purpose, and Values
- Mission – We improve health every day.
- Purpose – Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being.
- Values – People, Quality, Patient Safety, Service, and Integrity.
Sentara Healthcare Commitments
Sentara has made a commitment to its colleagues, patients, and members to:
- Always keep you safe.
- Always treat you with dignity, respect, and compassion.
- Always listen and respond to you.
- Always keep you informed and involved.
- Always work together as a team to provide you with quality healthcare.
Sentara Benefits
As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:- Medical, Dental, and Vision Insurance
- Paid Annual Leave, Sick Leave
- Flexible Spending Accounts
- Retirement funds with matching contribution
- Supplemental insurance policies, including legal, Life Insurance and AD&D among others.
- Work Perks program includes discounted movie and theme park tickets among other great deals.
- Opportunities for further advancement within our organization
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!Please Note: Yearly Flu Vaccination are required for employment.
#indeed, #LI-AB1
For applicants within Washington State, the following hiring range will be applied: $116,407.20 - $147,267.12.
Candidates must have residency in one of the following states to work remotely in this position:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming
Key words: Clinical Pharmacy, PBM, Director Pharmacy PBM, remote, managed care
The Director of Utilization Management (UM) is responsible for providing oversight to the daily functions of the UM staff and monitoring staff performance in accordance with Health Plan policies and procedures. Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of the managed care members' performance across the continuum of care to include the complete transition of care to outpatient care. Leads special projects, reviews of UM programs, and evaluation of UM performance, as indicated by contract, regulatory and/or accreditation requirements. Collects, analyzes, audits and reports UM program trends and quality outcomes. Provides clinical and operational oversight of each UM initiative which includes analysis of clinical data to drive performance improvement. Develops, implements, and monitors policies and procedures for contract and accreditation compliance. Provides recommendations to senior leaders on healthcare strategies, product development, policy and procedure changes and/or cost control opportunities.- Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP)
- Registered Nurse (RN) Single State - Nursing License - West Virginia
- Registered Nurse (RN) Single State - Nursing License - Wisconsin
- Registered Nurse (RN) Single State - Nursing License - Wyoming
- Registered Nurse License (RN) - Nursing License - Other/National
- Registered Nurse (RN) Single State - Nursing License - Alabama
- Registered Nurse (RN) Single State - Nursing License - Arizona
- Registered Nurse (RN) Single State - Nursing License - Arkansas
- Registered Nurse (RN) Single State - Nursing License - Colorado
- Registered Nurse (RN) Single State - Nursing License - Delaware
- Registered Nurse (RN) Single State - Nursing License - Florida
- Registered Nurse (RN) Single State - Nursing License - Georgia
- Registered Nurse (RN) Single State - Nursing License - Idaho
- Registered Nurse (RN) Single State - Nursing License - Indiana
- Registered Nurse (RN) Single State - Nursing License - Iowa
- Registered Nurse (RN) Single State - Nursing License - Kansas
- Registered Nurse (RN) Single State - Nursing License - Kentucky
- Registered Nurse (RN) Single State - Nursing License - Louisiana
- Registered Nurse (RN) Single State - Nursing License - Maine
- Registered Nurse (RN) Single State - Nursing License - Maryland
- Registered Nurse (RN) Single State - Nursing License - Mississippi
- Registered Nurse (RN) Single State - Nursing License - Missouri
- Registered Nurse (RN) Single State - Nursing License - Montana
- Registered Nurse (RN) Single State - Nursing License - Nebraska
- Registered Nurse (RN) Single State - Nursing License - New Hampshire
- Registered Nurse (RN) Single State - Nursing License - New Jersey
- Registered Nurse (RN) Single State - Nursing License - New Mexico
- Registered Nurse (RN) Single State - Nursing License - North Carolina
- Registered Nurse (RN) Single State - Nursing License - North Dakota
- Registered Nurse (RN) Single State - Nursing License - Oklahoma
- Registered Nurse (RN) Single State - Nursing License - South Carolina
- Registered Nurse (RN) Single State - Nursing License - South Dakota
- Registered Nurse (RN) Single State - Nursing License - Tennessee
- Registered Nurse (RN) Single State - Nursing License - Texas
- Registered Nurse (RN) Single State - Nursing License - Utah
- Bachelor's Level Degree
- Master's Level Degree
- Nursing 5 years
- Managed Care 5 years
- Coordination
- Critical Thinking
- Judgment and Decision Making
- Leadership
- Learning Strategies
- Mathematics
- Mgmt of Financial Resources
- Mgmt of Material Resources
- Mgmt of Staff Resources
- Microsoft Excel
- Microsoft Word
- Monitoring
- Persuasion
- Project Management
- Quality Control Analysis
- Reading Comprehension
- Science
- Service Orientation
- Social Perceptiveness
- Speaking
- Systems Analysis
- Systems Evaluation
- Technology/Computer
- Time Management
- Troubleshooting
- Writing
- Active Learning
- Active Listening
- Communication
- Complex Problem Solving
- 4 Days Ago
- US Office of the Director of National Intelligence
-
Mc Lean, VA
FULL_TIME
- Duties Contribute to the planning and evaluation of the related strategic planning documents in support of United States (U.S.) national security and foreign policy interests and programs. Support ass...
- 9 Days Ago
- US Office of the Director of National Intelligence
-
Mc Lean, VA
FULL_TIME
- Duties Plan, schedule, and initiate activities regarding the examination and analysis of budget requests and execution data to ensure accuracy and consistency with National and Intelligence Community ...
- 1 Month Ago
- US Office of the Director of National Intelligence
-
Mc Lean, VA
FULL_TIME
- Duties Prepare, analyze, and forecast budgetary and financial information to evaluate continual change in program plans and funding and their effect on financial and budget program milestones. Analyze...
- 1 Month Ago
- US Office of the Director of National Intelligence
-
Mc Lean, VA
FULL_TIME
- Duties Perform personnel management responsibilities with a focus on building a high-performance workforce; promote team building and a collaborative work environment; ensure goals and performance obj...
- 2 Days Ago
- Humana
-
Allen, VA
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...
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