What are the responsibilities and job description for the Director of Utilization Management position at St. Tammany Health System?
At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system.
We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.
Job Description And Position Requirements
Scheduled Weekly Hours: 40
Summary of the Job:
The Department Head of Utilization Management directs and manages the day to day activities of the Utilization Management and Clinical Documentation Improvement Departments. The departments’ objectives are to increase efficiency in delivery of quality health care services and to ensure appropriate clinical and financial documentation required for proper payment.. The Department Head determines policies and procedures that incorporate best practices and ensure effective utilization reviews. The DH 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 DH consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Creates functional strategies and specific objectives for the departments and develops budgets/policies/procedures to support the functional infrastructure.
Minimum Qualifications: Graduate of an accredited School of Nursing. Requires Bachelor’s Degree in Nursing or healthcare related field. Five to ten years of hospital clinical experience with demonstrated administrative skills and extensive knowledge in reimbursement methodology. Knowledge of ICD-10-CM/PCS and CPT codes, their application to reimbursement and documentation and an understanding of Medical Records functions. Must maintain current licensure in the State of Louisiana.
Supervisor of Utilization Managers, Clinical Documentation Specialists, and Clerical Assistant. Must have strong project management skills, excellent presentation and communication skills, and good assessment, analytical and computer skills.
Physical Demands:
Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required. Must be able to work with a moderate level of noise.
Physical Effort required:
Constant (67%-100%) – talking, hearing, seeing
Frequently (34%-66%) – NONE
Occasionally (1%-33%) – lifting, carrying, pushing/pulling, climbing (stairs, ladders, etc.), balancing, stooping, crouching, crawling, reaching, handling/feeling.
EMPLOYMENT
Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.
EQUAL OPPORTUNITY EMPLOYER
St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.
We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.
Job Description And Position Requirements
Scheduled Weekly Hours: 40
Summary of the Job:
The Department Head of Utilization Management directs and manages the day to day activities of the Utilization Management and Clinical Documentation Improvement Departments. The departments’ objectives are to increase efficiency in delivery of quality health care services and to ensure appropriate clinical and financial documentation required for proper payment.. The Department Head determines policies and procedures that incorporate best practices and ensure effective utilization reviews. The DH 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 DH consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Creates functional strategies and specific objectives for the departments and develops budgets/policies/procedures to support the functional infrastructure.
Minimum Qualifications: Graduate of an accredited School of Nursing. Requires Bachelor’s Degree in Nursing or healthcare related field. Five to ten years of hospital clinical experience with demonstrated administrative skills and extensive knowledge in reimbursement methodology. Knowledge of ICD-10-CM/PCS and CPT codes, their application to reimbursement and documentation and an understanding of Medical Records functions. Must maintain current licensure in the State of Louisiana.
Supervisor of Utilization Managers, Clinical Documentation Specialists, and Clerical Assistant. Must have strong project management skills, excellent presentation and communication skills, and good assessment, analytical and computer skills.
Physical Demands:
Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required. Must be able to work with a moderate level of noise.
Physical Effort required:
Constant (67%-100%) – talking, hearing, seeing
Frequently (34%-66%) – NONE
Occasionally (1%-33%) – lifting, carrying, pushing/pulling, climbing (stairs, ladders, etc.), balancing, stooping, crouching, crawling, reaching, handling/feeling.
EMPLOYMENT
Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.
EQUAL OPPORTUNITY EMPLOYER
St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.
