Utilization Review Care Management Director
Company: Intermountain Healthcare
Location: Las Vegas
Posted on: February 25, 2021
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
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,
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
Strategic: Duties include developing goals to meet the
Intermountain /Integrated Care Management/Region Strategic Plan and
employees accountable to goals.Scope
Multi-hospital Operational accountability for Utilization Review
Care Management, including direct reports at all facilities.
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
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
c) Develops processes to ensure excellence in revenue cycle
d) Assures utilization review care manager Registered Nurses and
Care Management Assistants are compliant with state and federal
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
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
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
5) Patient Engagement:
a) Assures that processes and programs are in place that supports
the achievement of patient satisfaction and service quality
b) Acts as a leader/mentor for staff in the Healing Commitments and
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
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
Physical Requirements:Interact with others requiring employee to
verbally communicate as well as hear and understand spoken
- 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 firstname.lastname@example.org . 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
Keywords: Intermountain Healthcare, Las Vegas , Utilization Review Care Management Director, Executive , Las Vegas, Nevada
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