Director Utilization Management chez UT Southwestern Medical Center

%3Cp%3E%3Cstrong%3EWHY UT SOUTHWESTERN?%3C/strong%3E%3Cbr%3EWith over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to %3Ca target=%22_blank%22 rel=%22noopener noreferrer%22 href=%22https://www.utsouthwestern.edu/newsroom/articles/year-2022/july-us-news-best-hospital.html%22%3EU.S. News %26amp; World Report%3C/a%3E, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you%27ll discover a culture of teamwork, professionalism, and a rewarding career!%26nbsp;%3Cbr%3E%3Cbr%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3Cbr%3EThe Director of Utilization Management works under minimal supervision to provide leadership guidance to the Utilization Management (UM) team by planning, organizing and supervising the activities of the staff. Responsible but not limited to all UM related activities such as admission reviews, concurrent reviews, utilization trends, patterns, communication with physician advisors and utilization trend reports to the Utilization Review Committee. Coordinates with other departments to identify potential opportunities to facilitate organizational improvement and success.%26nbsp;%3C/p%3E%3Cp%3E%3Cstrong%3EBENEFITS%3C/strong%3E%3Cbr%3EUT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:%3C/p%3E%3Cul%3E%3Cli%3EPPO medical plan, available day one at no cost for full-time employee-only coverage%3C/li%3E%3Cli%3E100% coverage for preventive healthcare-no copay%3C/li%3E%3Cli%3EPaid Time Off, available day one%3C/li%3E%3Cli%3ERetirement Programs through the Teacher Retirement System of Texas (TRS)%3C/li%3E%3Cli%3EPaid Parental Leave Benefit%3C/li%3E%3Cli%3EWellness programs%3C/li%3E%3Cli%3ETuition Reimbursement%3C/li%3E%3Cli%3EPublic Service Loan Forgiveness (PSLF) Qualified Employer%3C/li%3E%3Cli%3E%3Ca target=%22_blank%22 rel=%22noopener noreferrer%22 href=%22http://jobs.utsouthwestern.edu/benefits/#top%22%3ELearn more about these and other UTSW employee benefits!%3C/a%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3EEXPERIENCE AND EDUCATION%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ERequired%3C/strong%3E%3C/li%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EBachelor%27s Degree in Nursing (BSN)%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E5 years related experience in a healthcare organization in a management, business development, or planning position.%26nbsp;%3Cbr%3EMust have extensive knowledge of the utilization management process, including admission and concurrent reviews, appropriate status of the patients, peer to peer requirements, denial process, contracts, and applicable rules and regulations affecting reimbursement for healthcare services.%26nbsp;%3Cbr%3EProven record of identifying process improvement opportunities.%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EPreferred%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EMaster%27s Degree in Nursing (MSN)%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E7 years progressively responsible related experience%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EJOB DUTIES%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3EManages and directs Utilization Management nurses and coordinators.%3C/li%3E%3Cli%3EDetermines policies and procedures that incorporate best practices and ensure effective utilization reviews.%3C/li%3E%3Cli%3EManages and monitors admission reviews to ensure patients are placed in the correct status, and concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way.%3C/li%3E%3Cli%3EProvides analysis and reports of significant utilization trends, patterns, and impacts to resources.%3C/li%3E%3Cli%3EConsults with physician advisors, faculty and other professionals to develop improved utilization of effective and appropriate services.%3C/li%3E%3Cli%3EAnalyzes department processes for efficiency and effectiveness to ensure facilitation of optimum reimbursement while complying with government and private insurance policies.%3C/li%3E%3Cli%3EPresents analysis and reports of significant utilization trends, patterns, and impact to resources to the Utilization Review Committee.%3C/li%3E%3Cli%3EManages, develops, and coaches staff, building on individual strengths and assists in setting professional goals.%3C/li%3E%3Cli%3EDevelops orientation and ongoing department training to expand staff knowledge, confidence, proficiency in duties, and efficiency in productivity.%3C/li%3E%3Cli%3EImplements corrective actions and conducts performance evaluations.%3C/li%3E%3Cli%3ECompiles and maintains records, reports, and statistical information for evaluation and planning.%3C/li%3E%3Cli%3EProvides leadership, direction, and guidance on professional responsibilities and technical skills.%3C/li%3E%3Cli%3EEstablishes and maintains effective lines of communication on Utilization Management related issues with both internal and external entities.%3C/li%3E%3Cli%3EServes as the definitive resource to respond to inquiries related to Utilization Management.%3C/li%3E%3Cli%3ERepresents Utilization Management at various committees, professional organizations, and physician groups as needed.%3C/li%3E%3Cli%3EWorks closely with the Medical Director and physician advisors, ensuring value-based care and efficient resource utilization.%3C/li%3E%3Cli%3EPerforms other duties as assigned.%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3ESECURITY AND EEO STATEMENT%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ESecurity%3C/strong%3E%3Cbr%3EThis position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.%3Cbr%3E%3Cbr%3E%3Cstrong%3EEEO%3C/strong%3E%3Cbr%3EUT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.%3Cbr%3E%26nbsp;%3C/p%3E Postuler maintenant