System Director of Utilization Review

System Director of Utilization Review-7410-8145LifePoint Health Support Center

Description

System Director Utilization Review

Who we are :

At Lifepoint Health, we provide quality healthcare to rural communities. As a valued member of our team, you will be an integral part of a group working together to elevate Lifepoint's healthcare delivery network. Our network includes 60 community hospitals, 60 rehabilitation / behavioral health hospitals, and 250 additional sites of care across the United States. As an organization, we are dedicated to serving communities nationwide by providing exceptional care. We believe in the power of our talented teams and strive to create environments where employees find purpose and fulfillment.

What you’ll do :

Manages and directs the development and implementation of a Centralized Utilization Management Program across multiple hospitals (systems). Develops and manages programs that identifies appropriate admissions as concurrent and retrospective review for hospital reimbursement. Identify and assist in addressing opportunities with standard practice, quality improvement, and adherence to regulatory requirements and enterprise policies, procedures, and guidelines.

Possess a leadership style that empowers hospital programs to deliver on goals, address the current reality of situations, strategize, and develop options for improvement, plan the way forward to improvement.

Works closely with the AVPs of CM to train, educate, and mentor utilization review leaders and staff to maximize their potential to deliver organizational goals. Provide continuing education on standards of practice, quality improvement and adherence to regulatory requirements.

In addition, this role will act as a conduit between the revenue cycle, payer relations, and third-party revenue cycle partners to deliver a robust denials prevention program. This will be in collaboration with the local hospital leaders and staff to ensure quality performance standards are being met across each entity.

Responsibilities :

• Oversee the development, implementation, and performance management of Utilization Review services across Lifepoint Health.
• Lead Utilization Review operations to develop and implement centralized utilization review and authorization management services.
• Develop structure and processes to optimize staffing and productivity.
• Evaluate and implement tools to leverage technology for program accuracy and effectiveness.
• Coordinate data collection and reporting to optimize resource use.
• Collaborate with AVPs of Case Management, Revenue Cycle, hospital CFOs, and others to design processes for securing authorizations and preventing clinical denials.
• Supports patient care performance as measured by key indicators including level of care, length of stay, and compliance metrics.
• Work with system and hospital administrative leaders to ensure local execution of strategies.
• Develop market strategies and tactics that align with company goals.
• Develop proposals and secure approval for business cases to support comprehensive programs to prevent payer denials.
• Implement centralized utilization review and authorization confirmation teams and processes to support hospital revenue cycle processes.
• Lead implementation of new technology to support utilization review processes.
• Responds to audit requests from Regulatory and Payer Entities
• Participates with Revenue Cycle Team and Managed Care to provide trended data for meetings with payers.
• Comfortable interfacing with hospital executives to report clear opportunities and to develop strategies for ongoing risk mitigation with hospital O Teams the AVPs of CM.

Qualifications

What you’ll need :

Education :  Bachelor’s degree in nursing; master’s degree preferred

Experience :  1-2 years’ experience in a Centralized Utilization Review Leadership Role, 3-5 years of clinical experience in an acute care setting managing utilization review, medical necessity and denials management. Experience leading education training programs and / or community collaboratives, along with project management and performance improvement necessary.

Certifications : Certification in Case Management field with American Case Management (ACM) or Commission for Case Manager (CCM) preferred.

Licenses : Current licensure as a Registered Nurse in state of residence.

Why choose us :

As a team member of the Health Support Center, our goal is to support those that are in our facilities who are interfacing and providing care to our patients and community members. Our focus is to attract, retain, and empower a diverse and determined workforce. Our mission statement is at the heart of who we are and what we do : “Making Communities Healthier.” In this shared mission, we believe that our collective efforts will shape a healthier future for the communities we serve.

Benefits : We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

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Primary Location

Tennessee-Brentwood

Schedule

Full-timeWork ScheduleDay shift, 7-10 hr / shift, weekdays only