Director of Utilization Management

Job ID
2021-174421
Employment Type
Full Time
Department
Utilization Review
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
Monday - Friday (8:00 AM - 5:00 PM)
Work Schedule
8 Hour
Location
CA-Bakersfield

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

 

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

Position Summary:

 

The Director of Utilization Management is the senior lead over the utilization management nursing teams. They are responsible for the day-to-day operations of the UM nursing teams including preservice utilization review, concurrent inpatient review and retro claim  review. The UM director is also responsible for the oversight of utilization management auditing, both internal and external, for all DH MSO service areas as well as the developmentof UM work plans for submission to health plans as needed. They are the operational lead for bringing on new lines of business into the UM workflow. The Director is responsible for reviewing and providing program metrics to senior leadership as well as analysis of program and utilization statistics as well as delivering reporting to both UM and quality committee meetings. The director has direct leadership over teams of managers and direct reports across the service area.

 

#missioncritical

#casemanagement

#utilizationmanagement

Qualifications

Minimum Qualification:

  • Registered Nurse (RN) License
  • Master's degree in nursing or experience equivalent required
  • Five (5) years of progressive leadership experience in Care Management
  • Knowledge of federal, state and local healthcare related laws and regulation
  • Ability to comply with these in healthcare practices and activities
  • Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way

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