Director Utilization Mgmt

Overview

The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned area. They provide guidance and direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and works collaboratively with internal teams to optimize care delivery and achieve operational goals.

Responsibilities

• Ensure the use of nationally recognized criteria and evidence-based standards for inpatient concurrent reviews and offsite service requests.
• Manage UM staff including performance reviews, employee development, hiring, coaching, counseling, and retention.
• Lead UM process improvements, facilitate patient care goals, and utilize data research to reduce length of inpatient stays and decrease ED admissions.

• Evaluate and recommend policy improvement related to utilization review system, and provide UM updates and participate in meetings.
• Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical regarding offsite services.

Qualifications

Education

• Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university

Experience

• One (1) year of experience in utilization management is required.
• Excellent communication and organizational skills required.
• Experience in Performance and/or Quality Improvement preferred.

Licenses/Certifications

• Current license in state of employment to practice medicine