Utilization Management Director jobs in Washington, DC

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)

M
Director of Case Management and Utilization
  • medstar
  • Clinton, MD FULL_TIME
  • MedStar Health is looking for a Director of Case Management and Utilization to join our team! We are looking for a registered nurse or social worker with the ability to demonstrate ethical behavior that supports the hospital’s mission, values, and commitment to compliance with all federal, state, and regulatory laws. Inspires trust and exhibits honesty and integrity within the scope of daily activities. 

    The Director of Case Management and Utilization will develop, implement, and evaluate the strategic plan for the hospital-wide Case Management process. Provide operational supervision of case management department. Coordinate and support ongoing problem solving. Establish tools, processes, and systems to optimize the individual roles of the department. 

    Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move! 

     
    Primary Duties: 

    • Responsible for assuring compliance with hospital wide patient care quality monitoring in collaboration with the Performance Improvement Department. Assures performance improvement activities with ongoing monitors for the Case Management Department. Knowledge of the organization’s performance improvement priorities and outcomes. Assists the organization to achieve compliance in the Important Functions described in the Joint Commission.  

    • Provides direct supervision of utilization management activities as mandated by State/Federal regulations. Assures utilization criteria and monitors are approved by Medical Staff as appropriate. Maintains the program to assure coordination of patient services and financial issues related to reimbursement for care provided with all Managed Care Companies and outside providers. Assist Utilization Management Committee Chairman to prepare for meetings and comply with regulatory requirements. Assures appeals system is maintained and will coordinate with the Business Office for maximum reimbursement.  

    • A member of the Hospital Ethics Committee, the Clinical Pathways Committee, Medical Records Committee, and the Performance Improvement Committee. Implements changes and maintains systems for statistical reporting of Utilization Review activities and develops outcomes documentation and reporting as the Case Management program evolves. Maintains ongoing communication with staff on the nursing units to address concerns relative to Case Management issues. Responsible for ongoing education of medical staff, nursing, and other ancillary services effected by development of and changes to the Case Management program in keeping with the changing health care environment.  

    • Assures ongoing communication with key departments/providers to assure negotiation/facilitation of patient movement through the health care system. Provides daily ongoing supervision of Case Managers and the Social Workers for case management problems direction and resolution. Plans and participates in staff development as appropriate. Responsible for personnel function of the Department including work performance and recommendations regarding personnel actions for professional and support staff.  

    • Monitors and controls departmental utilization of hospital resources and makes recommendations to the Vice President of Professional Services regarding planned budgetary departmental needs and requirements. Maintains confidentiality in accordance with hospital policy. Communicates effectively and courteously with all patients, families, visitors, physicians, and hospital staff 

     

    Qualifications:  

    • Master’s degree in Health Administration, Business Administration, Science of Nursing or Social Work. 

    • 5-7 years' experience in utilization management, discharge planning, quality management or case management. 

    • 3-4 year’s clinical experience in an acute care setting. 

    • Management experience. 

    • Certification in Case Management required. 

    • RN or Social Work Licensure in Maryland required. 

  • 16 Days Ago

1
Associate Director Quality Control
  • 10000929 - Assoc Director Study Management
  • Rockville, MD FULL_TIME
  • Are you ready to take the lead in ensuring the hard work from the rest of the business is realized, as we reliably get every medicine out to patients without challenge? We are looking for an Associate...
  • 8 Days Ago

1
Senior Director Risk Management, Patient Safety Centre of Excellence
  • 10001069 - Director Patient Safety Sci
  • Gaithersburg, MD FULL_TIME
  • Introduction to role:Are you a seasoned professional in Risk Management with a broad knowledge in patient safety? Do you have the ability to provide leadership and strategic direction to the developme...
  • 16 Days Ago

U
Financial and Resource Management Officer
  • 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 ...
  • 3 Days Ago

U
Financial and Resource Management
  • 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...
  • 7 Days Ago

U
Strategy Management Officer
  • 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...
  • 1 Month Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Utilization Management Director jobs found in Washington, DC area

C
Managing Director Learning & Development
  • Confidential
  • Baltimore, MD
  • LOCATION Ft. Worth, TX; Wilmington, DE; Charlotte, NC; Evansville, IN, Baltimore, MD or New York, NY THE ROLE Reporting ...
  • 3/28/2024 12:00:00 AM

T
Managing Director, Industry Performance Benchmark Product
  • The Health Management Academy
  • Arlington, VA
  • About The Academy: The Health Management Academy (THMA) brings together health system leaders and innovators to collecti...
  • 3/28/2024 12:00:00 AM

S
Private Equity Associate / Senior Associate / Managing Director
  • Selby Jennings
  • Washington, DC
  • A well-established Buyout Private Equity firm that uses a variety of strategies when investing into Lower Middle Market ...
  • 3/28/2024 12:00:00 AM

A
Sr. Proposal Manager/Director
  • Arch Systems
  • Baltimore, MD
  • Job Description Job Description Role: Sr. Proposal Manager/Director Company: Arch Systems LLC Location: Remote Type: Ful...
  • 3/27/2024 12:00:00 AM

T
Knowledge Management Director, Transforming Local Food Processing
  • TechnoServe
  • Arlington, VA
  • Everyone deserves the opportunity to build a better future. This simple idea has been at the heart of TechnoServe's work...
  • 3/27/2024 12:00:00 AM

C
Managing Director, Sales & Solutions - Defense Sector
  • CBRE
  • Washington, DC
  • Managing Director, Sales & Solutions - Defense Sector Job ID 125713 Posted 11-Aug-2023 Service line GWS Segment Role typ...
  • 3/26/2024 12:00:00 AM

R
Sr Program Manager/Director
  • REI Systems
  • Sterling, VA
  • Job Description Overview REI is looking for an experienced Director to own client delivery, people management, growth, a...
  • 3/25/2024 12:00:00 AM

T
Managing Director, Benchmarking Product Launch
  • The Health Management Academy
  • Arlington, VA
  • About The Academy: The Health Management Academy (THMA) brings together health system leaders and innovators to collecti...
  • 3/24/2024 12:00:00 AM

Washington, D.C. is located in the mid-Atlantic region of the U.S. East Coast. Due to the District of Columbia retrocession, the city has a total area of 68.34 square miles (177.0 km2), of which 61.05 square miles (158.1 km2) is land and 7.29 square miles (18.9 km2) (10.67%) is water. The District is bordered by Montgomery County, Maryland to the northwest; Prince George's County, Maryland to the east; Arlington County, Virginia to the south; and Alexandria, Virginia to the west. The south bank of the Potomac River forms the District's border with Virginia and has two major tributaries: the An...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$140,586 to $190,098
Washington, District of Columbia area prices
were up 1.3% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020