What are the responsibilities and job description for the Director-Utilization Management position at Cedar Crest Hospital?
ESSENTIAL FUNCTIONS:
- Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
- Conducts and oversees concurrent and retrospective reviews for all patients.
- Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
- Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
- Collaborates with ancillary services in order to prevent delays in services.
- Evaluates the UM program for compliance with regulations, policies and procedures.
- May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
- Six or more year's clinical experience with the population of the facility preferred.
- Four or more years’ experience in utilization management required.
- Three or more years of supervisory experience required.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
Experience
Required- 4 year(s): Four or more years of experience in Utilization Management required.
Education
Required- Bachelors or better in Nursing/Healthcare
- Bachelors or better in Social Work
Licenses & Certifications
Required- Lic Prof Counselor
- Lim Lic Mast Social Work
- Reg Nurse
Skills
Required- Computer - Excel
- Leadership
- Communication
- Attention to Detail
Behaviors
Required- Team Player: Works well as a member of a group
- Loyal: Shows firm and constant support to a cause
- Leader: Inspires teammates to follow them
- Dedicated: Devoted to a task or purpose with loyalty or integrity
Motivations
Required- Goal Completion: Inspired to perform well by the completion of tasks
- Peer Recognition: Inspired to perform well by the praise of coworkers
- Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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