Ascension Health Regional Director- Utilization Management & Denial Avoidance in Lisle, Illinois
Job ID: 273185
Regional Director- Utilization Management & Denial Avoidance
Additional Job Information
Title: RN Dir-Util Mgmt ACM
City, State: Lisle,IL
Department: Total Quality Management 002
Additional Job Details: Full-Time,Day, 40 hours,Weekly
AMITA Health ( www.AMITAhealth.org ) is a joint operating company formed by the Adventist Health System in Altamonte Springs, FL and St. Louis, MO based Ascension.
With the addition of Presence Health, AMITA Health is now the largest health system in Illinois, comprising 19 hospitals and more than 230 sites of care. The newly combined health system has 900 providers in its medical groups, more than 26,000 associates and 7,000 physician partners and now serves over 4.3 million residents in the greater Chicagoland area.
Sets strategy and leads utilization management practice for AMITA hospitals, through collaboration with all members of the health care team to coordinate timely and efficient delivery of required services to result in:
Positive patient health care outcomes
Improved efficiency and standardization
Improved inpatient throughput from admission to discharge
Increased patient/health care team satisfaction
Leads and support UM managers and leaders in establishing policies and standard processes with respect to documentation of reviews, application of appropriate criteria and/or guidelines and documentation of review outcomes; applies constant evaluation of regulatory and payer changes to ensure UM team remains current with standards.
Identify and mitigate those clinical areas with the greatest level of care variation opportunities; monitors and implements solutions to ensure appropriate level of care to prevent pre and post claim denials.
Providing leadership in the planning, growth and operational management and team development
Drive towards optimal patient engagement and satisfaction and leverages people, process and technology to ensure efficiency and effectiveness
Model strong relationships with provider and clinical staff along with associated leadership and staff alike to support open collaboration and breakdown barriers to establishing joint workflow and policies with other departments/areas to influence decreased denials and appropriate reimbursement
Inform leadership regarding UM functions, challenges and accomplishments through routine and structured reporting
Conduct and support analysis needed to identify and mitigate changes needed to workflow, education and/or systematic enhancements.
Collaborate with legal and compliance to document/implement/update UM program and key policies.
Leads regional and enterprise initiatives providing expertise and performing root cause analysis where needed to implement sustainable improvements
Acts as a key contact and resource to investigate and follow up with external audits to address queries and perform needed analysis to respond and resolve findings as appropriate
Works closely with team, providers and education staff to identify, administer and measure needed training to ensure staff and team are up to current with regulatory and 3rd party payer requirements.
Actively manages external compliance and level of care support in collaboration with internal physician advisors.
- Licensed Registered Nurse credentialed from the Illinois Department of Financial and Professional Regulation obtained prior to hire date or job transfer date.
Bachelor's Level Degree
Graduate of an accredited Nursing Program required
Clinical nursing experience in a hospital and utilization review/case management experience required.
5 years clinical nursing experience in a hospital setting
3 years Utilization Review or hospital case management experience
3 years management experience
How To Apply
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Equal Employment Opportunity
AMITA Health will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.