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)
Centurion is proud to be the provider of comprehensive healthcare services to the Missouri Department of Corrections.
We are currently seeking a PRN Utilization Review Nurse to join our Missouri Regional Office Team located in Jefferson, Missouri.
The Utilization (UM) Nurse performs the review of requests for prior authorization of medical services, including diagnostic, outpatient care and services using defined criteria. Duties will include admissions though on-site and telephonic review to ensure medical necessity and appropriate level of care, review and audit of patient medical records as indicated to determine medical necessity, and serving as a clinical resource and liaison for site and hospital referral staff.
PRN
We offer excellent compensation and comprehensive benefits for our full-time team members including: