Utilization Management Director jobs in District of Columbia
Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Utilization Management Director jobs
Manager, Utilization Management Department
- The Elevance Health Companies, Inc.
-
WASHINGTON, DC
FULL_TIME
- Anticipated End Date: 2024-08-03 Position Title: Manager, Utilization Management Department Job Description: This position is located at our Washington, DC office with a requirement of 1-2 days onsite. The Mgr II HCMS is responsible for managing a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary duties may include, but are not limited to: Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan. Ensures continued compliance with specific medical management standards. Engages in the development process for medical and clinical management policy, procedures, and strategies. Evaluates medical, mental health, and substance abuse services for cost containment, to include complex/specialized member populations. Ensures program deliverables and compliance by monitoring established goals and implementing improvement strategies. Takes the lead within assigned area on ensuring the unit is positioned and prepared to execute on quality initiatives and activities including clinical indicators reporting, focus studies, HEDIS reporting and adherence to National Committee for Quality Assurance (NCQA) standards. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requirements: BA/BS in a related Health/Nursing field and minimum of 6 years of experience as aligned to appropriate license which includes 3 years prior management experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted RN, LCSW, LPC, LMHC or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply is required. Masters in related Health/Nursing field preferred. Certified Case Manager Certification preferred. Job Level: Manager Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
- 23 Days Ago
Executive Director Office of Small and Disadvantaged Business Utilization
- USAJOBS
-
Washington, DC
FULL_TIME
- DutiesThe Responsibilities Include, But Are Not Limited To Providing executive leadership, guidance, and consultation to the Office of Small and Disadvantaged Business Utilization. Oversees the day-to...
- 4 Days Ago
Executive Director Office of Small and Disadvantaged Business Utilization
- US Office of the Secretary
-
Washington, DC
FULL_TIME
- Duties The responsibilities include, but are not limited to: 1) Providing executive leadership, guidance, and consultation to the Office of Small and Disadvantaged Business Utilization. 2) Oversees th...
- 18 Days Ago
Deputy Director Field Policy and Management
- US Office of Field Policy and Management
-
Washington, DC
FULL_TIME
- Duties The Deputy Director of Field Policy and Management (FPM) reports to the Director of FPM. The Deputy Director assists the Director and the Assistant Deputy Secretary for FPM by providing support...
- 11 Days Ago
Deputy Associate Director for Performance and Personnel Management
- US Office of Management and Budget
-
Washington, DC
FULL_TIME
- Duties This position is in the Senior Executive Service (SES), a group of top government leaders. As an executive, you will influence the direction of innovation and transformation of the federal gove...
- 27 Days Ago
Deputy Director - Case Management for Individual Assistance
- Case Management for Individual Assistance - Tetra Tech Careers
-
Washington, DC
FULL_TIME
- Discover your full potential. At Tetra Tech, we are collaborating with industry-leading experts for a sustainable future for our world. We combine consulting and engineering with advanced analytics an...
- 28 Days Ago
Utilization Management Director jobs at Popular Companies
Managing Director
- Principal Financial Group
-
Miami, FL
- Managing Director - Miami; Principal Financial Network 42364 Sales Regular Full-Time Miami, Florida No A048000-West Cent...
- 6/11/2024 12:00:00 AM
Managing Director, Conflict Management & Dispute Resolution
- Dallas College
-
Dallas, TX
- Position Summary The Managing Director of Conflict Management & Dispute Resolution will be responsible for effectively d...
- 6/10/2024 12:00:00 AM
Managing Director
- Selby Jennings
-
Miami, FL
- Are you passionate about driving impactful change in infrastructure and sustainability? Do you thrive in dynamic environ...
- 6/10/2024 12:00:00 AM
Managing Director
- Experis
-
Winston-Salem, NC
- Build your career with Experis, a ManpowerGroup company as we connect human potential to the power of business. Through ...
- 6/9/2024 12:00:00 AM
Managing Director
- NEWMARK
-
Dallas, TX
- Job Description Newmark (NMRK) is one of the world's leading commercial real estate advisory firms. We provide a fully i...
- 6/9/2024 12:00:00 AM
Managing Director / Senior Managing Director - Debt Advisory
- Oberon Securities, LLC
-
New York, NY
- Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
- 6/8/2024 12:00:00 AM
Managing Director Investment Management
- Leadenhall Search & Selection
-
- Leadenhall Search & Selection are currently recruiting for Directors and Partners on behalf of a global, fast-growing In...
- 6/8/2024 12:00:00 AM
Senior Relationship Manager - Director - Managing Director
- Deutsche Bank
-
Miami, FL
- Job Description: Job Title Relationship Manager Corporate Title Director to Managing Director Location Miami, FL Overvie...
- 6/7/2024 12:00:00 AM
About District of Columbia
Washington, D.C. is located in the mid-Atlantic region of the U.S. East Coast. Due to the District of Columbia retrocession, the city has a total area of 68.34 square miles (177.0 km2), of which 61.05 square miles (158.1 km2) is land and 7.29 square miles (18.9 km2) (10.67%) is water. The District is bordered by Montgomery County, Maryland to the northwest; Prince George's County, Maryland to the east; Arlington County, Virginia to the south; and Alexandria, Virginia to the west.
The south bank of the Potomac River forms the District's border with Virginia and has two major tributaries: the An...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$141,499 to $191,336
Most Popular Cities in District of Columbia for Utilization Management Director Jobs
What does a Utilization Management Director do?
Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
February 09, 2020
Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
February 18, 2020
Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019