Director Utilization Management
Case Management Society of America (CMSA) ®, Bellaire, TX, United States
Job Number: 179437, Job Title: Director Utilization Management, Salary: $148,366.40 - $192,899.20
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health's robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet(r) nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
JOB SUMMARY The Director of Utilization Management reports to the Vice President HIM Coding CDI & UM and serves as the change agent for the planning, oversight, and implementation of system-wide and pavilion-specific strategic plans and programs related to utilization management and utilization review. In collaboration with service initiatives, the Director of Utilization Management will ensure standardization and direction to utilization using creative approaches to engage stakeholders in collaboration with system and pavilion operations across the organization. Activities include developing data reporting, data visualization activities to utilize data for decision making. Leveraging the development and implementation of programs and processes designed to promote patient-centered excellence, sustaining DNVGL‑NIAHO accreditation requirements, and collaboration with other division and department leaders, the Director will ensure clarity and conformity regarding utilization expectations, responsibility, accountability in alignment with the system's strategic plan, and medical necessity regulatory requirements, documentation standards, policies and other programmatic activities to enhance a value-based approach to professional practice, and thoughtful optimization of investments in support of utilization within the healthcare system. Other duties include the coordination of the Utilization Committees with administrative oversight of a team to accomplish a value-based approach to ensure performance, access, experience and cost effectiveness. Exercises a competency-based approach in the evaluation of policies, as a content expert on topics related to the Utilization Review/Utilization Management (UR/UM) that focuses on delivery system evidence-based outcomes, research-valued, and targeted to achieve system and departmental goals.
MINIMUM QUALIFICATIONS
Education/Specialized Training/Licensure: Graduation from an accredited school of nursing with a Bachelor of Science in Nursing Degree and a Master's Degree: MSN or MBA or MHA. Nurse Executive and/or Nursing Informatics or relevant certification. Registered Nurse: Current license or valid permit to practice professional nursing in Texas.
Work Experience: Ten years of System Level Healthcare-Based Strategic Planning Experience and/or Operational Oversight.
Management Experience: Five years supervisory experience.
Equipment Operated: Regular office equipment.
SPECIAL REQUIREMENTS
Communication Skills: Exceptional Verbal (Public Speaking) and Writing / Composing (Correspondence / Reports).
Other Skills: Analytical, including data analytics, CRT Design Medical Terms Research, P.C., MS Word, MS Excel.
Advanced Education: Bachelor's Degree Major: Science in Nursing. Master's Degree Major: MSN or MBA or MHA.
Work Schedule: Flexible.
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Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health's robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet(r) nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
JOB SUMMARY The Director of Utilization Management reports to the Vice President HIM Coding CDI & UM and serves as the change agent for the planning, oversight, and implementation of system-wide and pavilion-specific strategic plans and programs related to utilization management and utilization review. In collaboration with service initiatives, the Director of Utilization Management will ensure standardization and direction to utilization using creative approaches to engage stakeholders in collaboration with system and pavilion operations across the organization. Activities include developing data reporting, data visualization activities to utilize data for decision making. Leveraging the development and implementation of programs and processes designed to promote patient-centered excellence, sustaining DNVGL‑NIAHO accreditation requirements, and collaboration with other division and department leaders, the Director will ensure clarity and conformity regarding utilization expectations, responsibility, accountability in alignment with the system's strategic plan, and medical necessity regulatory requirements, documentation standards, policies and other programmatic activities to enhance a value-based approach to professional practice, and thoughtful optimization of investments in support of utilization within the healthcare system. Other duties include the coordination of the Utilization Committees with administrative oversight of a team to accomplish a value-based approach to ensure performance, access, experience and cost effectiveness. Exercises a competency-based approach in the evaluation of policies, as a content expert on topics related to the Utilization Review/Utilization Management (UR/UM) that focuses on delivery system evidence-based outcomes, research-valued, and targeted to achieve system and departmental goals.
MINIMUM QUALIFICATIONS
Education/Specialized Training/Licensure: Graduation from an accredited school of nursing with a Bachelor of Science in Nursing Degree and a Master's Degree: MSN or MBA or MHA. Nurse Executive and/or Nursing Informatics or relevant certification. Registered Nurse: Current license or valid permit to practice professional nursing in Texas.
Work Experience: Ten years of System Level Healthcare-Based Strategic Planning Experience and/or Operational Oversight.
Management Experience: Five years supervisory experience.
Equipment Operated: Regular office equipment.
SPECIAL REQUIREMENTS
Communication Skills: Exceptional Verbal (Public Speaking) and Writing / Composing (Correspondence / Reports).
Other Skills: Analytical, including data analytics, CRT Design Medical Terms Research, P.C., MS Word, MS Excel.
Advanced Education: Bachelor's Degree Major: Science in Nursing. Master's Degree Major: MSN or MBA or MHA.
Work Schedule: Flexible.
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