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Utilization Management Director jobs in Kansas

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

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Utilization Management Clinical Processor - Mississippi
  • Avēsis
  • Home, KS FULL_TIME
  • Join us for an exciting career with the leading provider of supplemental benefits!

    Our Promise

    Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

    Summary

    The Utilization Management Clinical Processor will be responsible for timely and accurate review of medical necessity determinations for urgent and contractually required requests on a 24/7, 365-day basis ensuring federal, state, NCQA or contractual requirements are met. You will perform first level review of medical necessity cases based on a member’s eligibility and covered services outlined for each client contract. Under the direction of the supervisor, you are responsible for completing medical necessity reviews. Using clinical knowledge and experience, the Utilization Management Clinical Processor reviews the provider request for treatment, working closely with members and provider to collect all information necessary to perform a thorough medical necessity review.

    The Utilization Management Clinical Processor will use his/her professional judgment to evaluate the request and ensure that services are appropriately approved. You will apply clinical criteria that is laid out per our national criteria set forth by our Clinical Dental Consultants. In addition, our chosen candidate will maintain current knowledge and understanding of and regularly apply the laws, regulations, and policies that pertain to the organizational business units and uses clinical judgment in their application.

    Essential Job Functions

    • Conducts reviews of prior authorizations by providers -- determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials.
    • Understands and upholds Avesis’ policies and obligations relative to the Utilization Management reviews required by each client contract.
    • Documents approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract.
    • Maintains a daily level of productivity in accordance with departmental requirements for production and quality standards.
    • Maintains effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions; and actively participates in routine departmental meetings.
    • Other Duties as assigned.

    Requirements

    • Must live in the state of Mississippi
    • Minimum of 2 of years’ experience in dental benefit administration or related role.
    • X-Ray certification is highly preferred.
    • Dental Hygienist required.
    • 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required.
    • 1-3 years of experience managing multiple projects simultaneously while delivering results according to timelines
    • 1-3 years of experience working in a fast-paced, rapidly changing environment,
    • 1-3 years of experience working with highly confidential information including PII, HIPAA Ability to maintain confidentiality.
    • 1-2 years of experience with utilizing windows-based computer programs, along with strong skills in navigating and utilizing MS Office suite applications such as Excel, Word, and PowerPoint.

    FLSA Status: Hourly/Non-Exempt

    Salary Range: $18.33 - $28.67 per hour.

    How To Stay Safe

    Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

    Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

    We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

    To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

    We Offer

    • Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
    • Competitive compensation package.
    • Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
    • Life and disability insurance.
    • A great 401(k) with company match.
    • Tuition assistance, paid parental leave and backup family care.
    • Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
    • Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
    • Employee Resource Groups that advocate for inclusion and diversity in all that we do.
    • Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

    Equal Employment Opportunity

    At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!

  • 11 Days Ago
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Director of Residential Management
  • Price Brothers Management Company
  • Overland Park, KS FULL_TIME
  • Job Description: Join a team with 100 years in the multi-family industry! Price Brothers Management Company is currently hiring a Director who is experienced in all aspects of residential management. ...
  • 29 Days Ago
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Executive Director
  • Frontline Management
  • Garden, KS FULL_TIME
  • Garden Valley Retirement Community is seeking a dynamic well-versed Executive Director!We are seeking an experienced Executive Director to oversee all operations, functions and activities. The Executi...
  • 11 Days Ago
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Director of Nursing D.O.N.
  • Frontline Management
  • Garden, KS FULL_TIME
  • Garden Valley Retirement Community is seeking a Director of Nursing to join our leadership team!Are you an RN seeking a career in clinical leadership? Then come join our Garden Valley Retirement Commu...
  • 11 Days Ago
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Director of Financial Management
  • The State of Kansas
  • Shawnee, KS FULL_TIME
  • Important Recruitment Information for this vacancy: Job Posting closes: June 16, 2024 Department of Administration, Office of Financial Management https://admin.ks.gov/offices/financial-management Abo...
  • 4 Days Ago
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Director of Case Management
  • Labette Health
  • Parsons, KS FULL_TIME
  • Category: Nursing Administration Department: Quality/Case Management Description: Summary: A registered nurse that assumes the responsibility and accountability for the coordination and facilitation o...
  • 4 Days Ago
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Utilization Management Director jobs at Popular Companies

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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
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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
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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
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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
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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
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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
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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
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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
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About Kansas

Kansas /ˈkænzəs/ (listen) is a U.S. state in the Midwestern United States. Its capital is Topeka and its largest city is Wichita, with its most populated county being Johnson County. Kansas is bordered by Nebraska on the north; Missouri on the east; Oklahoma on the south; and Colorado on the west. Kansas is named after the Kansa Native American tribe, which inhabited the area. The tribe's name (natively kką:ze) is often said to mean "people of the (south) wind" although this was probably not the term's original meaning. For thousands of years, what is now Kansas was home to numerous and divers...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$121,031 to $163,658

Most Popular Cities in Kansas 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