Director, UM in Lubbock, Texas at TEXASCONNECT INC

The Director of Utilization Management responsible for the overall operations and direction of the Utilization Management department. The Director is responsible for developing policies and procedures that incorporate best practices and ensure effective utilization reviews. The Director manages and ensures productivity of the department in completing concurrent reviews to ensure that the patient is getting the right care in a timely, safe, efficient and cost-effective way. Additionally, the Director must monitor retrospective reviews after treatment has been completed or after discharge. Works collaboratively with Care Management leadership in providing feedback about any opportunities, trends, gaps regarding avoidable days or delays or develop a plan when a patient is no longer meeting acute level of care. Additionally, the Director works closely with physicians and other providers including the Physician Advisor to develop improved utilization of effective and appropriate services. identifying improvement opportunities, monitors performance in real time to effectuate strategic goal to increase reimbursement and decrease denials.

SPECIFIC SKILLS NEEDED
• Must have knowledge of Utilization Management procedures in acute care setting.
• Must have superlative people and results oriented professional management and customer service skills including proven time management, organizational and prioritization skills.
• Must possess excellent verbal and written communication skills and thorough knowledge of processes and details integral to utilization review and clinical documentation improvement
• Must have experience in planning and effectively managing departmental budgets and other fiscal responsibilities.
• Must be able to demonstrate ability and skill through prior experience and/or academic expertise in actively leading and managing large-scale change.
• Must have expertise in data management and analysis related to length of stay, case mix, resource utilization, etc. with the intent of identifying opportunities for improvement as well as validating current performance.
• Must have current knowledge of federal and health plan audit programs such as CMS RAC and other related audit activities, value-based purchasing programs, readmission and other related oversight programs resulting in denied reimbursements
• Must have the ability to perform cost-benefit and detailed strategic analysis on data and information sets an develop reports accordingly.
• Must have working knowledge of computer applications such as Excel, Word, and PowerPoint.

Required:
• Active California RN License
• BSN Required
• Minimum of two (3) years’ experience in case management, utilization review, and discharge planning in an acute care hospital
• Minimum of two (2) years leadership and department management experience.

Preferred:
• Master’s in Health Administration or related business field preferred
• Case Manager Certification (CCM) or (Accredited Case Manager (ACM) preferred