Ascension Health
Market Director of Utilization Management
Ascension Health, Nashville, Tennessee, United States,
Ascension Health Market Director of Utilization Management Nashville, Tennessee Apply Now
Schedule:
Monday - Friday. 40 hours week.Hospital:
Ascension Saint ThomasLocation:
Onsite - Nashville, TN. This position requires some traveling to Ascension Saint Thomas hospitals throughout the TN market.We’re looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you’ll lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. You’ll collaborate with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and innovate? Apply now!ResponsibilitiesProvide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.Ensure integration of utilization management functions with network strategy and claims processing.Oversee work with provider relations on resolving issues.Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.Oversee implementation and maintenance of prior authorization codes for all clients.RequirementsLicensure / Certification / Registration:Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.Education:Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.Master's degree or combination of Bachelor's degree and experience preferred.Work Experience:5 years of experience required.10 years of experience preferred.2 years of leadership or management experience required.5 years of leadership or management experience preferred.Why Join Our TeamAscension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non-profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee consisting of 16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities. Across the state, Ascension Saint Thomas and its partner organizations employ more than 11,000 dedicated associates who care for millions of patients each year. Ascension Saint Thomas is part of Ascension, one of the nation’s largest faith-based healthcare organizations committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. Ascension includes approximately 134,000 associates, 35,000 affiliated providers and 140 hospitals, serving communities in 19 states and the District of Columbia.Equal Employment Opportunity EmployerAscension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
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Schedule:
Monday - Friday. 40 hours week.Hospital:
Ascension Saint ThomasLocation:
Onsite - Nashville, TN. This position requires some traveling to Ascension Saint Thomas hospitals throughout the TN market.We’re looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you’ll lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. You’ll collaborate with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and innovate? Apply now!ResponsibilitiesProvide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.Ensure integration of utilization management functions with network strategy and claims processing.Oversee work with provider relations on resolving issues.Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.Oversee implementation and maintenance of prior authorization codes for all clients.RequirementsLicensure / Certification / Registration:Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.Education:Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.Master's degree or combination of Bachelor's degree and experience preferred.Work Experience:5 years of experience required.10 years of experience preferred.2 years of leadership or management experience required.5 years of leadership or management experience preferred.Why Join Our TeamAscension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non-profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee consisting of 16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities. Across the state, Ascension Saint Thomas and its partner organizations employ more than 11,000 dedicated associates who care for millions of patients each year. Ascension Saint Thomas is part of Ascension, one of the nation’s largest faith-based healthcare organizations committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. Ascension includes approximately 134,000 associates, 35,000 affiliated providers and 140 hospitals, serving communities in 19 states and the District of Columbia.Equal Employment Opportunity EmployerAscension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
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