JOB SUMMARY:

The Director of Utilization Management reports to the SVP Care Transitions & Integration and serves as the change agent for the planning, oversight, and implementation of system-wide and pavilion-specific strategic plans and programs related to utilization management and utilization review. In collaboration with service initiatives, the Director of Utilization Management will ensure standardization and direction to utilization using creative approaches to engage stakeholders in collaboration with system and pavilion operations across the organization. Activities include, developing data reporting, data visualization activities to utilize data for decision making. Leveraging the development and implementation of programs and processes designed to promote patient-centered excellence, sustaining DNVGL-NIAHO accreditation requirements, and collaboration with other division and department leaders. The Director will ensure clarity and conformity regarding utilization expectations, responsibility, accountability in alignment with the system's strategic plan, and medical necessity regulatory requirements, documentation standards, policies and other programmatic activities to enhance a value-based approach to professional practice, and thoughtful optimization of investments in support of utilization within the healthcare system.

Other duties include the coordination of the Utilization Committees with administrative oversight of a team to accomplish a value-based approach to ensure performance, access, experience and cost effectiveness. Exercises a competency-based approach in the evaluation of policies, as a content expert on topics related to the Utilization Review/Utilization Management (UR/UM) that focuses on delivery system evidence-based outcomes, research-valued, and targeted to achieve system and departmental goals.


MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: Graduation from an accredited school of nursing with a Bachelor of Science in Nursing Degree and a master's degree: MSN or MBA or MHA;
Accredited Case Manager through American Case Management Association (ACMA) (Or) Certified Case Manager through Commission for Case Manager Certification (CCMC) (AND) Registered Nurse Current, valid registration to practice in the State of Texas.


2. Work Experience (Years and Area): Ten years of System Level Healthcare-Based Strategic Planning Experience and/or Operational Oversight
3. Management Experience (Years and Area): Five years supervisory experience
4. Equipment Operated: Regular office equipment


SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing (Correspondence / Reports )

2. Other Skills:

Analytical, including data analytics CRT Design Medical Terms Research P.C. MS Word MS Excel

3. Advanced Education:

Bachelor's Degree Major: Science in Nursing Degree
Master's Degree Major: MSN or MBA or MHA


4. Work Schedule: Flexible