The Division Director of Utilization Review, under the direction of the BSWH System Director of Clinical Resource Management,will provide leadership and oversight to hospital departments of utilization review for the assigned division. The Director is responsible for implementing consistent policies and practices across all facilities within the division and developing monitoring tools to ensure processes are adhered to and meet regulatory compliance standards.
WHAT IS EXPECTED (ESSENTIAL FUNCTIONS):
- Directs daily UR operations for the division including budget, staffing, recruitment, performance management, training and special projects
- Develops/revises/updates departmental policies and procedures, work processes and staffing plans
- Establishes and monitors departmental performance indicators, goals and objectives that are consistent with the Revenue Cycle and BSWH strategic objectives, mission, vision and values
- Develops and maintains management reports for senior leadership, hospital senior leadership and senior medical staff
- Evaluates facilities' Utilization Management (UM) Plan on an annual basis and ensures the UM
- Plan meets regulatory compliance standards - Oversees facilities' Utilization Management Committee
- Serves as liaison in the area of utilization review/management for hospital and physician leaders
- Hires, evaluates, counsels, develops and manages Utilization Review Leadership in the division
- Acts as backup to vacancies in management positions related to Utilization Review at assigned facilities
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of InterQual or equivalent evidence based criteria for hospital admission
- Computers skills including working knowledge of Excel
- Executive presentation skills
- Process redesign, project management change management
QUALIFICATIONS
- Bachelor's degree in Nursing
- Master's degree preferred
- 5 plus year's related experience
- Registered Nurse
For formal consideration please click here to apply.
