Director Of Utilization Management

Position Overview

The Director of Utilization Management is responsible for overseeing the handling and coordinating all functions of the Utilization and Bill Review Departments including all staff and budgetary requirements.

Roles And Responsibilities

• Adhere to all deadlines and state statutes.
• Provide training and orientation for new staff along with staff of longevity when rules/laws and/or business practices change.
• Stewardship Meetings
• Assists staff when there is an influx of business, staff shortage, and or special circumstance; ability to use good judgment; thoroughness; dependability; tact; and courtesy.
• Assists in promoting and furthering the objectives of the IME Division.
• Provides customer service functions including but not limited to:
• Comply with State and National regulations; ability to follow instructions along with communicates these instructions based on various resources such as: insurance rules, billing practices, local government, national/state regulations.
• Performs other related duties incidental to the work described herein.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Oversee the review of injury and claim information to select the appropriate physician for the peer exam or record review.
• This position assists in IT management, budgeting, coordinating services, problem solving, establishing policies and procedures, and overall functioning of the Utilization and Bill Review Department.
• Maintains confidentiality and security in all aspects of performance.
• This position works closely with Sales, Case Management, Utilization Review, IME, and Accounting Departments to reach the common goal. Perform a variety of duties necessary to run an efficient department.
• Reviews Intake process for accuracy and timely completion of assignments.
• Meeting clients with sales and calls with clients
• Plan and schedule meetings and appointments; organize and maintain paper and electronic files; manage projects; conduct research; and disseminate information by using the telephone, mail services, Web sites, and e-mail; ability to maintain confidential information for claimants and physicians along with work product and proprietary information.
• Oversees the Utilization and Bill Review department staff, operations, service processes and outcomes, work schedules, conducts meetings, interviews, reviews, new employee orientations and disciplinary counseling.
• Adhere to Ethos Policies and Procedures and as appropriate to job functions.

Qualifications

Education

• CCM Preferred
• RN with active unencumbered multi-state license and CA.
• Bachelors degree or higher preferred

Experience

• 3+ years of customer service experience.
• URAC Accreditation Experience required.
• 5+ years of utilization management experience.
• Healthcare or medical administrative experience preferred.

Skills/Knowledge

• Computer knowledge required, including Microsoft Office products.
• Ability to multi-task.
• Excellent interpersonal skills.
• Strong oral and written communication skills.
• Able to perform as part of a team.
• Strong organizational skills.
• Discretion and confidentiality.
• Excellent customer service skills.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.

Job Posted by ApplicantPro