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Director, Utilization Management Jobs

Company

Sentara Healthcare
Address , Glen Allen, 23060, Va
Employment type
Salary
Expires 2023-07-23
Posted at 1 year ago
Job Description

Sentara Health Plans is currently hiring an experiencedDirector, Utilization Management to work in our Optima Health plan office, VA Beach, VA (Remote) Required experience:Previous Management experience - 5 years minimum Nursing experience - 5 years minimum Required Education:Minimum Bachelor's level degree ORMSN - Master's in Science and Nursing ORDoctorate level nursing degreeWhat is expected:Provides leadership, education, and strategic direction for managers and clinical staff and clinical operations. Managing process and workflow changes related to areas of responsibility. Assumes responsibility and accountability for operations and success of assigned areas. Supports and facilitates continuous efforts to improve organizational and clinical performance. Ensures quality of care meets or exceeds regulatory standards and requirements as measured by the division clinical quality indicators. Provides leadership for all staff development functions. Ability to interact with a wide audience to implement change.

The Director of Utilization Management (UM) is responsible for providing oversight to the daily functions of the UM staff and monitoring staff performance in accordance with Health Plan policies and procedures. Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of the managed care members' performance across the continuum of care to include the complete transition of care to outpatient care. Leads special projects, reviews of UM programs, and evaluation of UM performance, as indicated by contract, regulatory and/or accreditation requirements. Collects, analyzes, audits and reports UM program trends and quality outcomes. Provides clinical and operational oversight of each UM initiative which includes analysis of clinical data to drive performance improvement. Develops, implements, and monitors policies and procedures for contract and accreditation compliance. Provides recommendations to senior leaders on healthcare strategies, product development, policy and procedure changes and/or cost control opportunities.
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  • Master's Level Degree
  • Bachelor's Level Degree
  • Managed Care 5 years
  • Nursing 5 years
  • Learning Strategies
  • Technology/Computer
  • Systems Analysis
  • Mgmt of Financial Resources
  • Active Listening
  • Communication
  • Coordination
  • Active Learning
  • Reading Comprehension
  • Quality Control Analysis
  • Systems Evaluation
  • Monitoring
  • Mgmt of Material Resources
  • Microsoft Excel
  • Troubleshooting
  • Mathematics
  • Service Orientation
  • Judgment and Decision Making
  • Writing
  • Leadership
  • Persuasion
  • Project Management
  • Complex Problem Solving
  • Speaking
  • Time Management
  • Mgmt of Staff Resources
  • Science
  • Social Perceptiveness
  • Microsoft Word
  • Critical Thinking