Dir Corp Utilization Mgmt - #1840918
MHC00-McLaren Health Care
Dir Corp Utilization Mgmt- (21011706)
Responsible for assisting the VP Integrated Care Management in providing program oversight and monitoring across McLaren Health Care. Develops strong partnerships and interfaces with subsidiary senior leadership teams and key physician leaders to reach the goals and objectives of the ICM departments, which include achieving the highest accuracy of medical necessity, patient placement, collaboration with payers to ensure proper level of care and bed status for accurate reimbursement outcomes
Essential Functions and Responsibilities:
- Acts as a resource and provides ongoing education for utilization management staff and the organization regarding national and regional trends; adjusts care management model to meet financial, regulatory, and clinical goals for the hospital in collaboration with VP Integrate Care Management and senior leadership.
- Assists in the development of utilization management processes, policies, and practice standards
- Develops annual goals/performance management assessments and performs staff evaluations, develops and trains staff and participates in the staff hiring process
- Assist with the continued development and creation of utilization management workflow within the EMR(s) to achieve best practice workflows and standardization
- Assists the care mangers with the coordination of utilization management review activities to ensure that patients requiring referral care and/or services receive them in a timely manner.
- Communicates with MHC subsidiary leadership to support utilization management initiatives, dashboard metrics, and key performance indicators (KPIs).
- Bachelor Science in Nursing (BSN)
- Current Registered Nurse license in the state of practice
- Ten years of utilization management leadership experience in an acute healthcare facility
- American Case Management Certification (ACM) or obtain certification when eligible as defined by the Association Case Management Association, and maintenance of continuing education requirements
- Member of the American Case Management Association (ACMA)
- Master’s degree in healthcare, nursing or business
- Previous utilization management leadership experience
- Certification in Case Management Certification (ACM or CCM)