Director, Utilization Management

Emory Healthcare/Emory University

Atlanta, GA

Apply

JOB DETAILS

SALARY

SKILLS

Aftercare, Analysis Skills, Best Practices, Certified Case Manager (CCM), Communication Skills, Continuous Improvement, Cost Effectiveness Analysis, Data Analysis, Finance, Genetics, Health Education, Health Insurance, Healthcare, Healthcare Administration, Healthcare Management, Healthcare Providers, Healthcare Reimbursement, Hospital, Insurance Regulations, Interpersonal Skills, Leadership, Legal, Maintain Compliance, Management Strategy, Medical Treatment, Member Orientation, Nursing, Nursing Administration, Organizational Development/Management, Organizational Skills, Patient Care, Performance Management, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Project/Program Management, Quality Metrics, Quality of Care, Registered Nurse (RN), Regulations, Regulatory Compliance, Resource Utilization, Strategic Planning, Team Lead/Manager, Training/Teaching, Trend Analysis, Utilization Management

LOCATION

Atlanta, GA

POSTED

6 days ago

Overview

Be inspired. Be rewarded. Belong. At Emory Healthcare.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: + Comprehensive health benefits that start day 1 + Student Loan Repayment Assistance & Reimbursement Programs + Family-focused benefits + Wellness incentives + Ongoing mentorship, _development,_ and leadership programs + And more

Work Location:

Atlanta, GA

Description

The

Director of Utilization Management

plays a pivotal role in our healthcare system by overseeing and optimizing the utilization of resources and services across our organization. Utilization management includes, but is not limited to, analyzing entrance into care environments from multiple perspectives including payors, healthcare system, patient/family, and providers; ensuring appropriate and high quality care in the most appropriate setting and most appropriate cost; analyzing the effectiveness of treatment before, during and after care delivery; and, developing relationships with and educating payors, healthcare executives, patients and families, and providers. This position is responsible for developing and implementing utilization management strategies that align with our commitment to high quality and safe care, outstanding patient experience, cost-effectiveness, and regulatory compliance.

Strategic Planning:

+ Develop and execute utilization management strategies that align with the organization's mission, vision, and values + Collaborate with senior leadership to establish short-term and long-term objectives

Team Leadership:

+ Lead and manage a team of utilization management professionals, including nurses, case managers, and analysts, to ensure efficient and effective utilization of resources

Utilization Review:

+ Implement systemwide utilization review processes and policies to assess the appropriateness of healthcare services, medical treatments, and length of stay + Make recommendations for adjustments as needed

Quality and Process Improvement:

+ Collaborate with the Office of Quality to continuously improve care delivery processes and outcomes + Ensure adherence to quality standards and regulations

Operational Efficiency:

+ Develop and monitor utilization management programs that control internal and external costs without compromising the quality of care, making data-driven decisions to reduce unnecessary resource utilization

Data Analysis:

+ Utilize data and analytics to identify trends, opportunities for improvement, and areas where resource utilization can be optimized + Educate direct reports in utilization of data and analytics to drive performance improvement + Regularly report findings and recommendations to the executive team

Regulatory Compliance:

+ Stay informed about healthcare regulations and reimbursement policies, ensuring that the organization complies with all relevant laws and guidelines + Ensure that each direct report is aware of these and practices the same

Interdepartmental Collaboration:

+ Foster effective communication and collaboration with various departments, including medical staff, finance, nursing, and administration, to ensure seamless utilization management

Education and Training:

+ Provide training and education to staff members regarding utilization management processes, policies, and best practices

Reporting:

Prepare and present regular reports to senior leadership on utilization management initiatives, outcomes, and performance indicators

Required Minimum Qualifications:

+ Masters degree in healthcare management, nursing, or a related field + Valid healthcare administration license or certification (e.g., Registered Nurse, Certified Professional in Healthcare Management) + Proven leadership experience in utilization management or a related field within the healthcare industry + In-depth knowledge of healthcare regulations, insurance, and reimbursement policies + Strong analytical, problem-solving, and data-driven decision-making skills + Excellent interpersonal, communication, and presentation skills + Ability to lead, motivate, and develop a high-performing team + Strong project management, process improvement, and organizational skills

JOIN OUR TEAM TODAY!

Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org . Please note that one week's advance notice is preferred.

Connect With Us!

Connect with us for general consideration!

Division

_Emory Healthcare Inc._

Campus Location

_Atlanta, GA, 30345_

Campus Location

_US-GA-Atlanta_

Department

_EHI Care Management_

Job Type

_Regular Full-Time_

Job Number

_166620_

Job Category

_Care Management_

Schedule

_8a-4:30p_

Standard Hours

_40 Hours_

Hourly Minimum

_USD $70.03/Hr._

Hourly Midpoint

_USD $81.19/Hr._ Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.

About the Company

Emory Healthcare/Emory University

Resume Resources

Free Resume Templates Free Resume Builder