Manager Utilization Management-Southwestern Health ...

Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Manager Utilization Management. The Manager of Utilization Management is responsible for the leadership of the Utilization Management team. The Manager of Utilization Management works in collaborative practice with the physicians and other members of the interdisciplinary care team to meet patient-specific and age-related patient needs, linking cost resource management to quality and patient care. The Manager of Utilization Management activities include direct leadership and oversight of utilization management, UM Compliance, and transition/discharge planning across the care continuum. The Manager of Utilization Management will ensure tasks and projects are consistent with company strategy, commitments, goals and timelines. Location: Farmers Branch Core Hours Full time, Monday through Friday, 8am-5pm Job Duties Manage and serve as a resource for the Utilization Management team. Demonstrates an understanding of funding resources, services, disease management, clinical standards and outcomes. Demonstrates an understanding of managed care trends, Medicare and Medicaid regulations, reimbursement and the effect on utilization of the different methods of reimbursement. Demonstrates the ability to evaluate utilization/resource/clinical care management data to identify trends, develop action plans, and program modification for improved outcomes. Facilitates communication and coordination between members of the healthcare team, involving the client when needed to minimize fragmentation in service. Empowers and mentors staff through timely and constructive feedback that encourages professional and program growth. Educates the client, family or caregivers, and members of the health care delivery team about treatment options, community resources, insurance benefits, and /or psychosocial concerns so that timely decisions can be made. Demonstrates the ability to develop departmental interfaces with internal and external customers to provide exemplary service and achieve goals. Demonstrates participation in interdisciplinary team rounds to address utilization/resources and progression of care issues. Assists in developing and implementing an improvement plan to address issues. Implements goals and objectives that support overall strategic plans of the organization Supports and works within annual department operating and capital budgets Maintains objectivity in decision-making, utilizing facts to support decisions Assists in eliminating boundaries to achieve integrated, efficient and quality service Achieves ongoing compliance with all regulatory agencies Manages and serves as a resource to employees and customers as demonstrated by visibility and knowledge of issues Completes all compliance, regulatory and process training within the specified timeline Demonstrates positive leadership attributes to others on the care management team Utilizes resources efficiently and effectively Maintains a safe environment. Participates in Performance Improvement activities Education Associate''s Degree in Nursing (ADN) with an additional 2 years'' experience will be accepted in lieu of a Bachelor''s in nursing (BSN) required. Or, Bachelor''s Degree in Nursing required. Master''s Degree Nursing preferred Experience 7 years Utilization Management experience in an acute or post-acute provider or health plan (with ADN) required. Or, 5 years Utilization Management experience in an acute or post-acute provider or health plan (with BSN) required. 5 years staff management and leadership experience preferred Licenses and Certifications RN - Registered Nurse required upon hire Skills Working knowledge and ability to apply professional standards of practice in work environment and utilize medical criteria for decision-making. Working knowledge of computers and basic software applications used in job functions such as word processing, databases, spreadsheets, etc. Strong analytical and organizational skills. Knowledge of specific regulatory, managed care requirements. Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region''s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N'' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region. The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation''s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017. At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all. We invite you to learn more about us at Let''s move healthcare forward - together. Additional Information Location: Dallas, Texas, United States Travel: No Shift: Day Job Schedule: Full-time Pay Basis: Hourly Minimum Salary: US Dollar (USD) 41.58 Market Salary: US Dollar (USD): 50.00 Maximum Salary : US Dollar (USD) 60.94

Created: 2021-11-29