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Utilization Review Care Management Director

Company: Intermountain Healthcare
Location: Las Vegas
Posted on: February 25, 2021

Job Description:

Warm Springs 700 Office Job Description:The Utilization Review Care Management Director is responsible for providing leadership and administrative direction within multiple hospitals assuring coordination of Utilization Review activities among the multidisciplinary team of health care providers and throughout the continuum.
He/she will work in partnership with the Medical Staff, nursing, clinical, and Revenue Cycle leaders to ensure the provision of optimal patient care, attainment of financial goals, and development of leaders.
This position has multi-hospital accountability for Utilization Review care management services (to include cross departmental utilization review activities.
This position typically reports to the Integrated Care Management Director of Utilization Review and Utilization Management, and has accountability to the Chief Nursing Officers.

Typical Distribution of Job Duties: 30% Tactical, 60% Operational, 10% Strategic.

Tactical: Duties include ensuring appropriate staffing, availability of equipment, interdepartmental relations, and employee relations (day-to-day activities).
Operational: Duties include budget management, budget development, supply acquisition, process improvement, and employee
performance evaluations.
Strategic: Duties include developing goals to meet the Intermountain /Integrated Care Management/Region Strategic Plan and holding
employees accountable to goals.Scope

Multi-hospital Operational accountability for Utilization Review Care Management, including direct reports at all facilities.

Job Essentials

1) Leadership:
a) Oversees and directs the environment in which utilization review care management is practiced.
b) Develops the planning process for day-to-day operations, standards of care and attainment of organizational goals.
c) Directs collaborative problem solving among interdepartmental disciplines.
d) Allocates available resources to promote efficient, fiscally responsible, effective, safe and compassionate
e) care based on current standards of practice.
f) Responsible for shared decision-making and professional autonomy by providing input into executive-level decisions, and by keeping managers informed of executive level activities. Promotes and is supportive of regional research activities.
g) Responsible for the implementation of Intermountain Healthcare's mission, vision, and core values.
2) Operational Effectiveness:
a) Accountable for the financial management of designated utilization review care management areas, which includes the development, implementation and monitoring of annual capital/operating and personnel (FTEs) budgets.
b) Provide support and education to department managers for meeting financial goals.
c) Develops processes to ensure excellence in revenue cycle management.
d) Assures utilization review care manager Registered Nurses and Care Management Assistants are compliant with state and federal requirements.
e) Obtains and utilizes data for improvement of patient flow and other key performance indicators.
f) Facility education to ensure appropriate level of care.
3) Employee Engagement:
a) Models and fosters an environment of professionalism. Ensures competent and sufficient number of leadership staff to meet utilization review needs.
b) Guides the development of recruitment, retention, and employee satisfaction that keeps high performers in place and maintains focus on succession planning.
c) Acts as a role model through the demonstration of personal professional development, continuous learning and competency improvement.
d) Participates in and contributes to educational offerings and visibility in professional organizations.
4) Clinical Excellence:
a) Facilitates the delivery of safe high-quality patient care through clinical and non-clinical care coordination, on-going process evaluation, and reviewing clinical outcome metrics.
b) Supports clinical program protocols, and may provide ongoing monitoring and process improvement occurs to assure goals are achieved.
c) Collaborates with departments, physicians, service lines, payors, and community providers to achieve best clinical practices across the continuum through appropriate patient disposition.
d) Participating member of a professional care management organization.
5) Patient Engagement:
a) Assures that processes and programs are in place that supports the achievement of patient satisfaction and service quality goals.
b) Acts as a leader/mentor for staff in the Healing Commitments and Healing Connections.
6) Physician Engagement:
a) Collaborate with internal and external physicians to provide extraordinary care experiences for our patients and achieve clinical, operational, financial, and service goals.
7) Community Stewardship:
a) Forms community relationships and works to identify gaps in the continuum of care.
b) Understands and promotes the use of community resources to improve the patient experience.
c) Supports staff participation in outside community organizations such as volunteer health
d) clinics, health fairs and advisory boards for not for profit organizations.

Minimum Qualifications

Masters degree required in Nursing, Healthcare, or Business from an accredited institution (degree will be verified).

RN license required.

3 years management experience in Utilization Review, Care Management or related area.
- and -
5 years experience utilization review, care management, or related areas.

Physical Requirements:Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
- and -
Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.Location:Warm Springs 700 OfficeWork City:Las VegasWork State:NevadaScheduled Weekly Hours:40 Posted 20 Days Ago Full time R7744 About Us Being a part of Intermountain Healthcare means joining a world-class team of over 38,000 employees and caregivers while embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: Helping people live the healthiest lives possible. Our patients deserve the best in healthcare, and we deliver. To find out more about us, head to our career site here . ADA Statement: Intermountain Healthcare strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Equal Opportunity Employer Intermountain Healthcare is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or protected veteran status. Women, minorities, individuals with disabilities, and veterans are encouraged to apply. Thanks for your interest in continuing your career with our team!

Keywords: Intermountain Healthcare, Las Vegas , Utilization Review Care Management Director, Executive , Las Vegas, Nevada

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