Executive System Director of Utilization Management
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![]() United States, North Carolina, Morrisville | |
![]() 1025 Think Place (Show on map) | |
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Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: TheExecutive System Director of Utilization Management (UM)is a strategic and operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a complex academic health system and multiple community-based hospitals and care settings. This role provides enterprise-wide oversight to ensure clinically appropriate level of care, optimal patient flow, regulatory compliance, and effective and efficient management of healthcare resources in alignment with institutional goals. TheExecutive Director works closely with leaders from various departments-casemanagement, physician advisors, revenue cycle, medical staff, nursing, and informationsystems (ISD) to create a unified and standardized utilization management (UM)infrastructure. This collaboration ensures the delivery of high-quality,value-based care across the healthcare system. Responsibilities: 2.Leading People- Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower high-performing system-level UM leaders and staff through strategic recruitment, mentorship, and professional development. Nurture a culture of ongoing enhancement, accountability, and excellence within utilization management. Provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Ensures that team treats sensitive or confidential information appropriately. Works to improve and reinforce performance of others. Ensures adequate staffing and orientation and training of staff. 3.Leading Change- Drive the unification of diverse operational models across multiple hospital and care settings. Initiates and manages the change process, taking steps to remove barriers or accelerate its pace. Communicates a compelling vision and need for change that generates excitement, enthusiasm, and commitment to the process. Clearly communicates the direction, required performance, and challenges of change to all involved parties. Identifies and enlists the support of key individuals and groups to move the change forward. Obtains and provides resources to implement change initiatives. Serves as a role model by demonstrating commitment to innovation and continuous improvement in organizational performance. Designs, executes, monitors and evaluates recommendations for improvement. Works with entity leaders to develop standardization across the system. Collaborates with key leaders in the organization to optimize key clinical and financial outcomes within best practice, ethical, legal, and regulatory parameters. 4.Results Driven- Implement and optimize technology platforms (e.g. InterQual, MCG, EMR integrations) for efficient case review and documentation. Establish key performance indicators to monitor compliance with healthcare regulations, measure the effectiveness of the UM program including length of stay (LOS), level of care pre-claim and post claim denial rates, readmission, and analyze and track payer methods to deny or reduce payment. Pinpoint savings opportunities and deploy strategies to enhance resource efficiency. Manage budget and financial performance for utilization management. Understands the overall financial performance of the organization and applies financial concepts and practices. Other Information Other information: Job Details Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: System Care Management Work Type: Full Time Standard Hours Per Week: 40.00 Pay offers are determined by experience and internal equity Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: US:NC:Morrisville Exempt From Overtime: Exempt: Yes This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. |