RN Director of Utilization Management

RN Director of Utilization Management Eastern United States

The RN Director of Utilization Management leads with executive presence, builds credibility with physicians, and holds the line where clinical judgment meets financial reality. The Director communicates and presents with the polish senior administration expects, and delivers a consistent record of results against goals.

The RN Director thrives as a self starter, influencing physicians and peers without leaning on authority, adapting quickly to change, and navigating conflict with tact and diplomacy.

Qualifications:

Registered Nurse (RN) required

Bachelor Degree required

Master Degree in Nursing or another health related field preferred

Director of Utilization Management experience in an Acute Hospital Setting required

Certification in Utilization Review or Case Management (CPUR/CCM/ACM) preferred

Responsibilities:

Directs day to day operations of the Utilization Management department, holding the work to payer requirements and regulatory standards

Recruits, develops, and leads a high performing Utilization Management team aligned with hospital objectives

Owns the departmental budget and staff allocation so productivity standards hold consistently

Drives correct status assignment, fewer denials, and appropriate use of hospital resources

Monitors key performance indicators, length of stay, and financial goals, then adjusts where the data points

Partners with Physician Advisors on policy for status determination, medical necessity, denials and appeals, and physician education

Serves as the liaison between clinical and financial operations, working with Case Management, Managed Care, Patient Financial Services, and Patient Access to keep the review process moving

Educates and influences physicians, staff, and leadership on Utilization Review practice and on transitions of care

Provides data driven insight and strategic recommendations to hospital leadership on Utilization Management performance

Represents Utilization Management as the operational leader on committees covering resource utilization review, compliance, policy, and quality

How to Apply:

Interested candidates, please submit your resume to Michelle Boeckmann at Michelle@CMRecruiter.com .

Visit www.HealthcareRecruitmentPartners.com/Careers for full details and additional Case Management/Utilization Management opportunities. Feel free to share this information with colleagues who may be interested.

Contact Michelle Boeckmann | President, Case Management Recruitment

Direct: 615-465-0292 | Michelle@CMRecruiter.com www.HealthcareRecruitmentPartners.com/Careers

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