Director Utilization Management

Location: Indianapolis, IN
Great opportunity for a Director Utilization Management in the Indianapolis area of Indiana.

Responsibilities of the Director Utilization Management:
  • Director will join an already successful team and have oversight for referral management, telephonic utilization review, prior authorization functions, and case management programs and ensuring compliance government and contractual guidelines.
  • Support and perform case management, disease management and on site concurrent review functions as necessary.
  • Provide support to Provider Relations issues related to Utilization issues for hospitals and physician providers.
  • Coordinate efforts with the Member Services and Connections Departments to address members and providers issues and concerns in compliance with medical management requirements.
  • Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for the prior authorization unit.
  • Develop, implement and maintain policies and procedures regarding the prior authorization function.
  • Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes.
  • Compile and review multiple reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting.
Requirements of the Director Utilization Management:
  • Bachelor's degree in Nursing or equivalent experience.
  • 5+ years of nursing experience in an acute care setting or medical/surgical, pediatrics, or obstetric in a managed care environment.
  • 1+ years of utilization management and/or case management experience.
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
  • Current Indiana RN nursing license- or willing to obtain.
 
Regards,
 
Stacey Soilis
Full Cycle Healthcare Recruiter
Healthcare Employment Partners
Direct Line:
561 409-5777
Toll free: 855 423-7633
 ext. 200
Fax: 855 423-7634
stacey@hcepartners.com
www.hcepartners.com
   

   

 
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