Under the direction of the AVP of Clinical Review and Discharge Planning, the Director of Clinical Review maintains daily operations of the hospital Clinical Review Department. Excellent communication and interpersonal skills. Team building skills with the ability to function independently and interdependently as a member of the Care Management Leadership Team. Demonstrates the ability to be flexible in work schedules and coverage; this includes the ability to manage some staff remotely. Strong organizational, innovation, and problem-solving skills. Strong decision-making skills. Ability to establish strong team building with the both internal and external customers.
Directs daily UM operations for the department including staffing, schedules, recruitment, onboarding, and performance management. Responsible for maintaining budget and contributing to future budget development.
Monitors departmental performance indicators, goals and objectives that are consistent with organizational strategic goals, mission, and vision.
Monitors departmental objectives consistent with revenue cycle plan for DNFB, denials, and appeals. Monitors reports and workqueues. In collaboration with the AVP, Medical Director of UM annually evaluates the UM plan to meet compliance standards.
Maintain the quality of the review process among all personnel including development and implementation of staff audits that give meaningful and measureable data and an understanding of strengths and areas for improvement. Responsible for the development and implementation of process improvements. Reviews observation/SDS cases daily and initiates communication and referral activity to ensure correct status designation. Active participant in the Utilization Management Committee and subject matter expert who acts as a resource to the team. Recruits, evaluates, mentors, and conduct appropriate disciplinary actions for UM staff. Collaborates with Physician advisors, and AVP to assure workflows and cases are being addressed according to plan. The above are guidelines for the position but are not necessarily a delineation of all the actions/duties necessary to the job.
...in commission, Second-year $20-40K and our top sellers are taking home $200K+ Uncapped, bi-weekly paid, commission paid day-one-dollar... ...participating in our 90 day training program Fun, fast-paced work environment with planned team events and sales contests Great...
...health record solutions and services to C-suite, boards, physician and nurse leadership, and other senior healthcare leaders at health systems, independent hospitals, and ambulatory healthcare networks. Ultimately operating under the direction of the Regional Sales...
...We are looking for a creative, motivated, and highly skilled Social Media Content Creator to manage and grow our presence on Instagram,... ...online community. Content Strategy: Collaborate with the marketing team to develop and execute a content strategy that aligns...
...the most picturesque national parks!~ FREE Recreation Program and complimentary use of Rec Halls, Employee Gyms (Climbing Wall at JLL) and watersports equipment. ~$105/week Meal Plan covers 3 meals/day in the employee cafeteria We are committed to environmental...
...Business (preferred). Proficiency with MRP/ERP systems (experience with JD Edwards is a plus). Familiarity with tools like DocuSign and Salesforce. Advanced Excel skills and a strong grasp of international trade procedures and incoterms. Knowledge of export...