POSITION TITLE: Director, Utilization Management – Clinical or Non-Clinical
JOB NUMBER: 700-01P
DEPARTMENT: Utilization Management
GENERAL PURPOSE: The Director, Utilization Management provides direction and overall supervision of the utilization management programs (Pre-Certification, Inpatient and Skilled Nursing Facility) to impact resource management and population outcomes while meeting all state, federal and accreditation requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Effectively operate the UM Program and complete all required functions and tasks with a focus on a customer service oriented work environment which meets the needs of staff, providers and our members.
- Provide effective methods for recruitment, initial and ongoing training/education and professional growth to maximize staff satisfaction and retention.
- Develop successful methods and processes for mentoring of management staff in order to develop leadership skills needed for professional growth.
- Work closely with data analytical team in the development of necessary reporting for daily management of the department, but to also effectively measure key outcomes.
- Read, analyze and interpret laws, regulations, policies and procedures governing UM operations (established plan/state, federal and accreditation standards and criteria); assists in development of polices to effect changes in program operations and to assure ongoing compliance; determine and report on impact of proposed legislative and regulatory changes.
- Responsible for content of all departmental policies and procedures.
- Analyze work flows using the Plan’s core transaction system and other technology to optimize business processes and compliance requirements within the department.
- Other duties as requested or assigned.
EDUCATION and/or EXPERIENCE – NON-CLINICAL: A graduate degree in health administration, public health, business or a related field from an accredited institution of higher learning is required; minimum of three years general management or supervisory experience with increasing responsibility in a hospital, medical clinic or health program is required; or an equivalent combination of education, training and experience.
LICENSING AND CERTIFICATION – NON-CLINICAL: None required for this position.
EDUCATION and/or EXPERIENCE - CLINICAL: Registered Nurse with an associated Bachelor’s degree (BSN, MBA, MHA, MPH, or MSN desired) with an administrative focus from an accredited institution of higher learning is required; minimum of three years general management or supervisory experience with increasing responsibility in a hospital, medical clinic or health program is required; or an equivalent combination of education, training and experience.
LICENSING AND CERTIFICATION - CLINICAL: Active Registered Nurse in Florida
NECESSARY KNOWLEDGE, SKILLS AND ABILITIES: Understanding and use of statistics to affect population health outcomes. Ability to navigate and master proprietary software programs. Ability to read and interpret documents.
Excellent communication skills including good grammar, voice and diction. Strong analytical skills. Proficient in MS Office with basic computer and keyboarding skills.
PHYSICAL DEMANDS: The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to use hands 10 finger, handle, or feel objects, tools, or controls and talk or hear.
Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment.
ADDITIONAL INFORMATION: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Freedom Heath is a health plan with a Medicare contract. Medicare approved plans are available to anyone entitled to Part A and enrolled in Part B of Medicare qualifying through age or disability.
Ranked 7th largest growing company in America by “Inc. 500” in 2009, Freedom Health continues to experience phenomenal growth and we continue to seek talented and skilled professionals to grow with us.
Freedom embraces a culture of diversity and inclusion offering competitive salaries, benefits and promotional opportunities.