- Provides overall direction, design, development implementation and monitoring of utilization programs to meet the utilization goals while maintaining customer satisfaction.
- Analyzes root causes for spikes in utilization in Medicare Part A, B and D. Takes data driven approach when formulating utilization management solutions.
- Creates, manages and updates preferred specialist networks focused on cost-effectiveness and high quality.
- Creates, manages and updates, preferred medication/device formulary.
- Develops and implements disease management interventions to lower cost of care.
- Measures and tracks effectiveness of interventions through KPIs, scorecards and CRM system.
- Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
- Assures compliance with Federal, State, TJC, NCQA, other regulatory agencies and internal standards and requirements.
- Hires, coaches, trains and disciplines staff to ensure smooth operations in utilization management.
- Also facilitates educational training for medical staff on issues related to utilization management.
- Minimum three years of experience in directing utilization management and discharge planning in a clinic setting,
- Strong acumen in analytics - experience with creating, tracking KPIs and measuring ROI of programs,
- Demonstrated interpersonal, negotiation, and leadership skills.
- Effective oral and written communication skills.
- Up to 50% travel to medical centers across Florida
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Utilization Management Coordinator
3 days ago
Leon Health Miami, FL, United StatesUtilization Management Coordinator (RN) · Under the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regulatory guidelines and plan p ...
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Utilization Management
1 week ago
Solis Health Plans Miami, United StatesJob Description · Job DescriptionAbouts Us · Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal expe ...
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Utility Category Manager
3 weeks ago
American Wire Group Miami, United StatesJob Description · Job DescriptionSalary: · Overview · American Wire Group ("AWG"), a leading supplier of insulated and bare wire and cable products, and services for infrastructure applications, specializes in renewable energy (wind and solar) and electric utility transmission, ...
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Utilization Management Coordinator
3 weeks ago
Leon Health Miami, FL, United StatesUnder the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regulatory guidelines and plan policies. · ESSENTIAL DUTIES AND RESPONSIBI ...
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Hospital Reviewer/Utilization Manager
2 weeks ago
DOCTORS HEALTHCARE PLANS, INC. Miami, United StatesJob Description · Job DescriptionPosition Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure the appropriateness for the corresponding level of care utilizing evidence-based criteria. · Responsibilities:Uses a collaborative proces ...
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Energy and Utility Operations Manager
3 weeks ago
Miami Dade College Miami, United States Full timeAll applications must be submitted online by visiting · Direct Application URL: · Miami Dade College, Kendall Campus is now accepting applications for Energy and Utility Operations Manager. The Energy and Utility Operations Manager develops and executes a strategic energy conser ...
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Baptist Hospital of Miami Miami, United States Full timeBaptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, an ...
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Jackson Health System Miami, United States Full timePosition Summary: · The Physician Advisor (PA) serves as a clinical resource to the medical staff and Case Management/Social Work by providing identification, facilitation and resolution of utilization issues. · The PA role reports to the CMO, CUO or his/her designee. · The Ph ...
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Utilization Review Case Manager, Non-RN
2 weeks ago
InsideHigherEd Coral Gables, United States OTHERCurrent Employees:If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review th ...
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Utility Category Manager
1 day ago
American Wire Group Doral, United StatesJob Description · Job Description Salary: · Overview · American Wire Group ("AWG"), a leading supplier of insulated and bare wire and cable products, and services for infrastructure applications, specializes in renewable energy (wind and solar) and electric utility transmission ...
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Baptist Health South Florida South Miami, FL, United StatesThis position conducts concurrent retrospective reviews for clinical, financial, resource utilization. Coordinates with Healthcare team to achieve optimal efficient outcomes, decreasing length of stay (LOS) and avoiding delays/denied days. Helps drive change by identifying areas ...
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Jackson Health Miami, United States OTHERDepartment: Jackson Memorial Hospital- Case Management, Utilization Review · Address: 1611 NW 12 Ave, Miami, FL 33136 · Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month) · Why Jackson Memorial Hospital: Jack ...
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Assistant Utility Finance Manager
2 weeks ago
City of Sunrise FL Fort Lauderdale, United StatesNATURE OF WORK · This classification involves supervising the billing, customer service, and collections activities and staff in the utility billing operations for the City. An employee in this position supervises assigned staff; analyzes utility funds; reviews billing and collec ...
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Director of Utilization Management
4 weeks ago
Regis HR Group Doral, United StatesDevelops, manages and directs the Utilization Management programs for the primary care clinics. The key objective is to drive cost-effective, high-quality care with high provider and patient satisfaction. Develops and manages data-driven programs that emphasize appropriate admiss ...
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Utilization Management Coordinator
2 weeks ago
Leon Health Doral, United StatesNow hiring in Miami, FL · Utilization Management Coordinator (RN) · Under the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regu ...
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Utilization Management Coordinator
1 week ago
Leon Health Doral, United StatesNow hiring in Miami, FL · Utilization Management Coordinator (RN) · Under the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regula ...
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IT product manager
1 week ago
Atlas Dynamics Ida, United StatesIT Product Manager (m/f/d) · Hannover Information Technologies (hannIT) · Hannover · with professional experience · Annual salary: 56,024.00– EUR · The digital transformation is changing all areas of municipal administration. At hannIT, you can actively shape this change. han ...
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Utilization Management Coordinator
4 weeks ago
Leon Medical Centers Doral, United StatesUnder the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regulatory guidelines and plan policies. · ESSENTIAL DUTIES AND RESPONSIBI ...
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Baptist Health South Florida Miami, FL , USA, United StatesThe purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare Team for optimal efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. ...
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Jackson Health Miami, United States OTHERDepartment: Jackson Memorial Case Management, Utilization Review · Address: 1611 NW 12 Ave, Miami, FL 33136 · Shift: Per Diem, Day Shift, 8 Hours (Local Remote) · Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it h ...
Director of Utilization Management - Miami, United States - Regis HR Group
Description
Job Description
Job DescriptionDevelops, manages and directs the Utilization Management programs for the primary care clinics. The key objective is to drive cost-effective, high-quality care with high provider and patient satisfaction. Develops and manages data-driven programs that emphasize appropriate admissions as well as concurrent and retrospective review of care. Responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization Review program and Extended Care Coordination to promote a centralized, coordinated, interdisciplinary process in the continuum of care.Essential Responsibilities:
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