Director Central Utilization

Title: Director Central Utilization

Location: Work From Home

Full time

Job Description

Work From Home Work From Home, Indiana 46544

As Director of Central Utilization at Franciscan Health, you’ll guide a dedicated team committed to delivering quality, efficiency, and compassion across every inpatient experience. Partnering closely with leaders across the Franciscan Alliance, you’ll strengthen our triad model and advance system-wide excellence in utilization management.

 

WHO WE ARE

With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

 

 

WHAT YOU CAN EXPECT

 

• Travel as needed for in person CM Collaboratives

• Develop and update FA utilization management policies and procedures, work processes and staffing plans to enable FA to accomplish its UM goals.

• Collaborate with Director Clinical Denials to establish and monitor UM performance indicators.

• Develop management reports for FA senior leadership, hospital senior leadership and inpatient care management team

• Manage centralized UM staffing, recruitment, performance management and training.

• Promote FA compliance with CMS, State and Payer utilization management policies.

• Keep abreast of current trends in UM and Managed Care processes.

• Maintain current knowledge of Medicare, Medicaid and other payer rules, regulations, policies, and procedures.

• Develop collaborative partnership with payers responsible for the patients within FA to assure reimbursement for provided services.

• Support FA care management teams with Epic care management modules, Epic work queues, and other solutions by working closely with FAIS teams responsible for care management platforms.

• Develop, implement, and manage policies and a budget, ensuring cost control and expenses are in alignment with the budget.

• Supervise direct reports, perform people management activities and manage the performance of individuals through ongoing coaching, feedback and development.

 

 

QUALIFICATIONS

 

• Bachelor's Degree in Nursing or related field - Required

• Master's Degree Nursing or MBA/MHA - Preferred

• 8 years Utilization Management - Required

• Registered Nurse (RN) - State Licensing Board - Preferred - AND -

• Accredited Case Manager (ACM) - American Case Management Association (ACMA) - Preferred

• Previous leadership experience - highly desired

 

 

TRAVEL IS REQUIRED:

Up to 20%

JOB RANGE:

Director Central Utilization $137,653 - $182,080

INCENTIVE:Not Applicable

 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

 

Franciscan provides eligible employees with comprehensive benefit offerings.