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RN Director of Utilization Management

Company: Ascension (System Office)
Location: Sterling Heights
Posted on: June 14, 2018

Job Description:

Job ID: 257068 RN Director of Utilization Management Sterling Heights, Michigan Regular / Day Additional Job Information Title:--RN Director of Utilization Management City, State:-- Sterling Heights, MI Location:-- US Health Holdings/ABS Department:---- ACO Care Management 001 Additional Job Details:----FT, Days About Us Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world---s largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. In FY2017, Ascension provided more than $1.8 billion in care of persons living in poverty and other community benefit programs. Ascension includes approximately 165,000 associates and 34,000 aligned providers. Ascension---s Healthcare Division operates more than 2,600 sites of care --- including 153 hospitals and more than 50 senior living facilities --- in 22 states and the District of Columbia, while its Solutions Division provides a variety of services and solutions including physician practice management, venture capital investing, investment management, biomedical engineering, facilities management, clinical care management, information services, risk management, and contracting through Ascension---s own group purchasing organization. Job Description Job Summary: The RN Director of Utilization Management provides strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities:

  • Ensures integration of utilization management functions with network strategy and claims processing.
  • Oversees work with provider relations on resolving issues.
  • Manages activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
  • Develops systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.
  • Oversees implementation and maintenance of prior authorization codes for all clients. Qualifications Education:
    • Bachelor's degree in nursing, or combination of diploma from an accredited school/college of nursing and related experience required.
    • Master's degree in a related field, or combination of Bachelor's degree and related experience preferred. Work Experience:
      • 5 Years Required Technical Experience.
      • 10 Years Preferred Technical Experience.
      • 2 Years Required Leadership/Mgmt Experience.
      • 5 Years Preferred Leadership/Mgmt Experience. Equal Employment Opportunity Ascension Health is an EEO/AA employer: M/F/Disabled/Vet. For further information regarding your EEO rights, click on the following link to the ---EEO is the Law--- poster: -- Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. E-Verify Statement Ascension Health participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. Share: -->

        Keywords: Ascension (System Office), Detroit, RN Director of Utilization Management, Healthcare, Sterling Heights, Michigan

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