Director-Utilization Management
DescriptionConway Behavioral Health is seeking an experienced Director of Utilization Review to join our team to direct and manage the day-to-day operations of the Utilization Review department.
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 review s 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.QualificationsEDUCATION / 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.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
QualificationsExperienceRequired+ 4 years : Utilization management Equal Opportunity Employer / Protected Veterans / Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
41 CFR 60-1.35(c) Learn More
Director-Utilization Management
DescriptionConway Behavioral Health is seeking an experienced Director of Utilization Review to join our team to direct and manage the day-to-day operations of the Utilization Review department. Provide staff management to including hiring, development, training, performance management and communi...
Director-Utilization Management
Conway Behavioral Health is seeking an experienced Director of Utilization Review to join our teamto direct and manage the day-to-day operations of the Utilization Review department. Provide staff management to including hiring, development, training, performance management and communication to ensu...
Director-Utilization Management
Conway Behavioral Health is seeking an experienced Director of Utilization Review to join our team to direct and manage the day-to-day operations of the Utilization Review department. Provide staff management to including hiring, development, training, performance management and communication to ens...
RN Case Manager (Registered Nurse)
Full-and Part-Time Employee Benefits.Medical, Dental, and Vision Insurance Cancer plan.Paid time off (PTO) program Critical life events plan.Tuition and certification reimbursement Employee Assistance Program (EAP).Group Term Life Insurance and AD&D Free parking at all locations.Short term and L...
Registered Nurse / RN Case Manager
Our CompanyHospice Home CareOverviewOur Hospice Registered Nurse (RN) Case Managers are the heart of our organization! In this role, you will support your patients by providing direct care and coordinating with the interdisciplinary team to ensure that both patients and their families have an optima...
Registered Nurse
As a registered nurse (RN), you'll be the connection between compassionate care and the real, positive results your patients are striving to achieve. REGISTERED NURSE (RN), INPATIENT REHABILITATION. As a registered nurse at Encompass Health channel the full extent of your knowledge, skills, ambition...
Medical Equipment Operations District Manager
District Manager of Medical Device Operations. In this position you will be responsible for the day-to-day management of company operations. Maintains and updates all manuals necessary for company operations and establishes processes to evaluate location's compliance with applicable policies and pro...
Registered Nurse / RN Case Manager
Registered Nurse / RN Case Manager. Our Hospice Registered Nurse (RN) Case Managers are the heart of our organization! In this role, you will support your patients by providing direct care and coordinating with the interdisciplinary team to ensure that both patients and their families have an optima...
RN Case Manager (Registered Nurse)
Licensed as a Registered Nurse (RN) in Arkansas. Registered Nurse Case Manager. RN) who oversees and participates in the provision of appropriate clinical interventions and support to an assigned caseload of hospice patients. Manages the patient care functions after the initial admission and assignm...
Director of Engineering Operations
Proficient in Microsoft Office Suite, AutoCAD, and with various other software programs. The Director of Engineering is responsible for the oversight and management of the engineering department. Fosters a positive, metrics driven work culture of accountability, quality, and professional/career grow...