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Director, Utilization Management - San Antonio, TX - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | San Antonio, TX San Antonio, Texas |
About this job
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Director, Utilization Management Operations is responsible for planning, organizing, and directing the ancillary support for the Utilization Management team. The Director coordinates team coverage for the Prior Authorization / Hospital Intake team, the Correspondence team and the Medical Claims Review team to ensure compliance with regulatory, contractual and accreditation requirements. The success of this position requires the ability to foster communication and teamwork among physicians, medical management staff, corporate departments, vendors, and senior leadership.
Monday through Friday 8am-5pm
Primary Responsibilities:
- Monitors Prior Authorization / Hospital Intake call center operations ensuring that the overall performance of the department adheres to corporate and regulatory standards
- Oversees departmental functions, workflows, policies and procedures to ensure that all Federal and State regulations and contractual agreements are followed
- Oversees the implementation of processes and system enhancements which will improve the overall quality and service provided by the UM teams
- Analyzes trends and identifies/implements departmental initiatives based upon data provided through the reporting of production, quality, financial and audit data
- Provides input into and supports all applicable employee and other training programs for the department staff to ensure that regulatory compliance requirements are disseminated and understood
- Oversees the recruiting, performance, development and mentoring of service staff.
- Initiates cross functional/departmental discussions and initiatives to remove barriers and improve communications and work flows
- Identifies/initiates technology solutions to improve employee productivity and quality
- Actively participates in the management of the annual departmental budget
- Actively participates in the development of policies and procedures
- Performs all other related duties as assigned
Requirements
Required Qualifications:
- Unrestricted Texas RN license with ability to obtain license in other states as necessary
- Bachelor's Degree in Nursing, Business Administration, Health Care Administration or related field (Eight additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
- At least three years of experience at a manager level or above capacity in a call center environment within a managed care organization
- Knowledge of regulatory and accrediting standards relating to medical management and managed care
- Knowledge of medical terminology and claims processing
- Knowledge of fiscal management and human resource management techniques
- Ability to plan, supervise and review the work of non-clinical staff
- Requires working under stressful conditions or working irregular hours
- Creative problem-solving and communication skills
- Able to work effectively and achieve results in a real time, fast paced environment
- Analytical skills with strong organization skills
- Proficiency with Microsoft Office applications to include advanced Excel skills
Preferred Qualifications:
- Master's degree
- 8+ years of experience in managed care with 5+ years at a management level working in a call center environment
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Director, Manager, Utilization Review, UM, Case Management, CCM, Registered Nurse, RN, San Antonio, TX, Texas