Job Overview:
As System Director of Utilization Review at SouthEast Alaska Regional Health Consortium (SEARHC), you will play a vital role in ensuring the best healthcare for Alaska Natives and residents of Southeast Alaska. Join our team in promoting a healthy balance of mind, body, and spirit within our communities. This role is based in Juneau, Alaska and requires RN to be on site.

$156K DOE

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including:

• Sign on Bonus: $25K
• Relocation Bonus $10K
• Retirement
• Paid time off
• Paid parental leave
• Health, dental, and vision benefits
• Life insurance and long and short-term disability, and more.

Responsible for directing a system-wide utilization review process, including Case Management and Social Services, in multiple locations.

Must be able to understand and manipulate advanced systems and work with and synthesize large relational data sets, providing descriptive/predictive/prescriptive analytics to support operational behavior modification.

Meet and exceed department service, operational and financial goals, provide analysis, identification of variances and develop action plans to achieve established goals. Report unit performance to internal stakeholders as required.

This position works intensively with advanced systems to track and trend denials, builds models for documentation improvement plans, and coordinates with all areas and levels of Southeast Alaska Regional Health Consortium (“SEARHC”) Hospitals.

Work closely with revenue cycle and other finance staff to maximize revenues while maintaining compliance with regulations affecting utilization management. The position requires close interaction with and knowledge of the Medicare and Medicaid programs and other third-party payers.

This position works closely with the provider community to improve clinical documentation and with administration to ensure appropriate hospital resource use. Care coordination includes the internal collaboration with the SEARHC Primary Care Clinics and Long-Term Care facilities. External collaboration includes tertiary care, assisted living, and psychiatric facilities.

Education, Certifications, and Licenses Required

• Bachelor’s degree from an accredited school required.
• Higher level of education preferred.
• Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required. Direct Hire must have applied for an Alaska nursing license before start date.

Experience Required

• Prior experience in the utilization and review function required.
• Previous management experience in supervision or administration required.
• Prior experience working in a Critical Access Hospital model preferred.
• Five years of clinical experience preferred.
• Prior experience in Performance Improvement preferred.

Knowledge of

• Knowledge of health care service delivery systems and third-party reimbursement; knowledge of managed care environment.
• Solid understanding of healthcare, federal, and state regulations.
• Understanding of admission and discharge functions.
• Familiarity with medical terminology, diagnostic terms, and treatment modalities.

Skills in

• Strong interpersonal, organizational, evaluative, and time management skills.
• Policy interpretation skills; familiarity with applicable standards and regulations.
• Provider communication and behavior change can be challenging; this individual must be an expert communicator and change agent.
• Responsiveness to deadlines; assertiveness, persistence, and persuasiveness.

Ability to

• Ability to apply and interpret admission and continued stay criteria.
• Ability to organize tasks related to the accomplishment of hospital goals and objectives.
• Ability to work in a professional manner with physicians, outside agencies, and support staff.
• Ability to travel to multiple locations.

Join SEARHC's dedicated team where every career opportunity comes with competitive benefits, a supportive work culture, and the chance to make a difference in the lives of others. Embrace the small-town charm of Southeast Alaska while advancing your nursing career with us.

#SEARHC2

Job Type: Full-time

Pay: From $156,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Relocation assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Healthcare setting:

• Acute care
• Hospital
• Inpatient

Medical specialties:

• Critical & Intensive Care
• Medical-Surgical

Schedule:

• 5x8
• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• Utilization review: 2 years (Required)
• clinical: 5 years (Preferred)

License/Certification:

• RN License in the US (Required)

Ability to Commute:

• Alaska (Required)

Ability to Relocate:

• Alaska: Relocate before starting work (Required)

Work Location: In person