University of Maryland Medical SystemBaltimore
nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Acts as Program Manager of Division of Community Psychiatry...
University of Maryland Medical SystemBaltimore
Job Description
General Summary
Responsible for planning and managing the change management process and communications for the Center for Technology Innovation. Accountable for the overall quality of the change management process. Ensure requested...
Virtus Healthcare Staffing, LLCBaltimore
Job Title: Director - Revenue Cycle Management (RCM)
Location: Owings Mills, MD
Summary:
Virtus Healthcare Staffing is partnering with a leading healthcare provider in Owings Mills, MD, to identify an experienced and results-driven Director...
AT&TColumbia
AT&T has an opening for a SLA Manager/Data Analyst. The job duties of the SLA Manager/Data Analyst are as follows:. They may also guide the work of data analysts or tasks performed by contractors, vendors or partners. Our SLA Data Analyst (QS2) (Government) earns between.
...
JacobsSevern
We are looking for an experienced technical program manager for our space line of business that can join the team and lead $50M programs with DoD or IC customers successfully. Provide technical and management guidance to the program team and manage day to day functions on large DoD or IC program.
Le...
Army National GuardGunpowder
Defend the skies using complex technology as an Air Defense Battle Management System Operator for the Army National Guard. Job training for an Air Defense Battle Management System Operator requires 10 weeks of Basic Training, where you'll learn basic Soldiering skills, and 20 weeks of Advanced Indiv...
Capital OneBaltimore
West Creek 4 (12074), United States of America, Richmond, Virginia
Director, International Risk Management
Capital One is one of the fastest growing organizations in the world today and we are growing our teams globally. As Director...
GuidehouseAnnapolis Junction
This high performing team guides clients in effective overall financial management as well as corporate performance management. Demonstrates a thorough level of knowledge regarding process improvement in areas, such as shared service and outsourcing, finance transformation, performance management, f...
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MANAGER, UTILIZATION MANAGEMENT
Baltimore | www.resume-library.com |
Job Description
General Summary
Assume 24-hour accountability for managing the functions of Utilization
Management. With the Manager of Case Management and the Manager of Social Work, serves as the central resource to the Director of Care Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement.
To meet accountabilities of the Care Management Dashboard collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all duties.
Direct oversight of the Utilization Management Lead (s) and frontline Utilization Review staff.
Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested. Develops a growth plan for each employee.
Manages hiring and performance management of staff.
Keeps key statistics and participates in the maintenance of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
Manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
Manages structure and process to facilitate participation by physicians, rehabilitation, pastoral care, care coordinators, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
Participates and fosters performance improvement within the department and organizationally.
Oversees operational budget
Partners with physicians and the Physician Advisor (s) for effective relationships with physicians, services, specialties, etc.
Establishes collaborative relationships with owner of hospital contracts and reimbursement.
Participate in payer, Revenue Management Cycle and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to utilization management.
1Serves as educational and communications resource to Administration, Department Leadership, physicians and other necessary groups regarding the utilization review/management activity process.
Maintains a leadership role in the Utilization Committee and Plan as it relates to the conditions of participation.
General Summary
Assume 24-hour accountability for managing the functions of Utilization
Management. With the Manager of Case Management and the Manager of Social Work, serves as the central resource to the Director of Care Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement.
To meet accountabilities of the Care Management Dashboard collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all duties.
Direct oversight of the Utilization Management Lead (s) and frontline Utilization Review staff.
Completes annual and interim performance reviews for all staff and contributes to performance reviews of other professionals and support staff as requested. Develops a growth plan for each employee.
Manages hiring and performance management of staff.
Keeps key statistics and participates in the maintenance of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
Manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
Manages structure and process to facilitate participation by physicians, rehabilitation, pastoral care, care coordinators, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
Participates and fosters performance improvement within the department and organizationally.
Oversees operational budget
Partners with physicians and the Physician Advisor (s) for effective relationships with physicians, services, specialties, etc.
Establishes collaborative relationships with owner of hospital contracts and reimbursement.
Participate in payer, Revenue Management Cycle and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to utilization management.
1Serves as educational and communications resource to Administration, Department Leadership, physicians and other necessary groups regarding the utilization review/management activity process.
Maintains a leadership role in the Utilization Committee and Plan as it relates to the conditions of participation.
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