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Est. $11.00 - $11.35 Full-time, Part-time Salem, VA 24153 Urgently Hiring Est. $11.00 - $11.35 Full-time, Part-time Salem, VA 24153 Urgently Hiring
Director-Utilization Management - Full-time
Salem, VA 24153
30 days ago
$32 per hour
About this job
Direct and manage the day-to-day operations of the Utilization Review department.
- Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patients 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.
- 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 supervisoryexperience required.
- 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.