Director, Utilization Management

The Director of Utilization Management (UM) is an integral member of the Revenue Cycle division, working closely with financial and clinical operations to provide strategic direction in support of operational performance and key financial metrics. The Director is responsible for oversight of the day-today operations of all enterprise utilization management functions to include developing effective and efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of various commercial and government payers.

• Develops policies and procedures to ensure all hospitalized patients have the correct admission status (inpatient, outpatient short stay, observation status) so that the appropriate claim can be submitted to commercial and government payers at discharge.
• Develops and maintains efficient and effective documented policies and procedures for non-coverage notifications, including Notice of Non-coverage (HINN) and Advance Beneficiary Notice of Noncoverage (ABN), to include compliance monitoring.
• Oversee all Utilization Management functions to include daily operations management, budget, productivity, quality, education and training, auditing, report management, performance improvement initiatives and developing standardized practices, processes, policies and procedures. 
• Monitors the effectiveness/outcomes of the UM program, identifying and applying
  appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed.
• Collaborate with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to
  answer clinical questions related to medical necessity and patient status
• Monitors and analyzes the productivity and quality of utilization management operations, while providing ongoing feedback and education for the staff. Ensures compliance with regulatory requirements and application of clinical decision support criteria for utilization activities deemed by Federal, State and other regulatory and accreditation agencies. Serves as a key leader in UM work flow design and management under Epic financials. 
• Serves as Co-Chair of the Utilization Management Committee
• Understands interrelationships among systems and processes across functional areas to evaluate processes, improve efficiency, and ensure optimal results
• Actively seeks to promote and maintain a professional team-oriented, service-conscious culture that contributes to the goals of the department and organization.
• Fosters a positive and proactive work environment, emphasizing respect for individuals, high standards of quality, customer service, innovation and team work.
• Maintain personal professional growth and development through seminars, workshops and professional affiliations.

Position Compensation Range: –

MINIMUM REQUIREMENTS
Education:

Master’s degree in Science in Nursing

Experience:

Minimum five (5) years of healthcare financial management that includes revenue cycle or related experience working directly in Utilization or Case Management

Licensure:

CCM (certified case manager), CPUM (certified professional in utilization management), or other applicable certification preferred.

PHYSICAL DEMANDS
This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.

COVID Vaccination Requirement and Guidelines

Please visit the UVA COVID-19 Job Requirements and Guidelines  webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.

The University of Virginia, i ncluding the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician’s Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff.  We believe diversity is excellence expressing itself through every person’s perspectives and lived experiences.  We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.