Senior Director, Utilization Management
Apply NowCompany: CoreCivic, Inc.
Location: Brentwood, TN 37027
Description:
At CoreCivic, our employees are driven by a deep sense of service, high standards of professionalism and a responsibility to better the public good. CoreCivic is currently seeking a Senior Director of Utilization Management located at our corporate office in Brentwood, TN. Come join a team that is dedicated to making an impact for the people and communities we serve.
This position would require a hybrid work schedule of 3 days per week onsite and 2 days remote out of our Brentwood, TN office location.
SUMMARY:
The Senior Director, Utilization Management manages and directs the case management, scheduling, and utilization of services provided for the incarcerated population. Oversees and optimizes the utilization of medical services to ensure the delivery of high-quality, cost-effective patient care. Manages utilization review processes, develops, and implements utilization management policies and collaborating with clinical staff to promote efficient resource use.
ESSENTIAL FUNCTIONS:
The incumbent should be able to perform all of the following functions at a pace and level of performance consistent with the job performance requirements.
1. Oversees the utilization review process to ensure appropriate use of medical services and resources. Develops and implements strategies to optimize the efficiency and effectiveness of medical utilization. Monitors and analyzes utilization patterns to identify opportunities for improvement.
2. Oversees medical case management to ensure efficiency and maintain compliance with company policies and standards, and government laws and regulations.
3. Works across CoreCivic Health Services and Operations enterprise to ensure timely scheduling of offsite medical visits.
4. Provides direction, guides and supports staff in the development of cost-effective care plans for high-risk, high-cost cases by working with healthcare providers.
5. Manages highly complex medical events to determine the appropriate standard of care. Ensures the resolution of complicated disputes of healthcare providers.
6. Monitors legal, industry and economic variables, assessing contracted rates to adjust to the strategic landscape.
7. Maintains understanding of Provider Contracting & Centralized Scheduling workflows. Identifies potential process improvements and supports the design and implementation changes as requested, leveraging on-site and leadership where appropriate.
8. Develops, reviews, and updates utilization management policies and procedures to ensure compliance with regulatory standards and best practices. Collaborates with clinical and administrative departments to ensure policies are effectively communicated and implemented.
9. Compiles, evaluates, and reports statistics and trends to team members, and utilizes the information to facilitate process improvement. Works with the Health Services Quality Team to identify and address areas for improvement in medical utilization and patient care. Develops and implement initiatives to enhance the quality and efficiency of healthcare services.
10. Supervises staff in the performance of their duties and evaluates as prescribed by company policy. This includes, onboarding new employees, evaluating performance and preparing written performance reviews, listening to concerns and effectively resolving problems or issues, taking corrective or disciplinary action, developing work schedules for staff and approving leave requests.
11. Leads performance improvement and evaluation processes related to the management of patient care across the continuum. Collects trends and analyzes aggregate outcome data for the population to be used in identifying best practices and targeting performance improvement efforts.
12. Monitors case management, utilization, and scheduling metrics and develops and implements business solutions to address process and quality gaps. Works closely with physicians, nurses, and other healthcare professionals to promote efficient use of medical resources. Serves as a liaison between the utilization management department and other clinical and administrative departments.
13. Domestic U.S. travel may be required.
QUALIFICATIONS:
Graduate from an accredited college or university with a Bachelor's degree in Nursing (BSN) is required.
Master's degree in Nursing preferred.
Five years of professional nursing practice experience required.
Demonstrated leadership and management skills with knowledge and application of case management, care delivery models, healthcare delivery systems, and CQI process experience required.
Certification from the American Case Management Association (ACMA) or Commission for Case Manager Certification (CCMC) is preferred.
Proficiency in Microsoft Office applications required.
This position would require a hybrid work schedule of 3 days per week onsite and 2 days remote out of our Brentwood, TN office location.
SUMMARY:
The Senior Director, Utilization Management manages and directs the case management, scheduling, and utilization of services provided for the incarcerated population. Oversees and optimizes the utilization of medical services to ensure the delivery of high-quality, cost-effective patient care. Manages utilization review processes, develops, and implements utilization management policies and collaborating with clinical staff to promote efficient resource use.
ESSENTIAL FUNCTIONS:
The incumbent should be able to perform all of the following functions at a pace and level of performance consistent with the job performance requirements.
1. Oversees the utilization review process to ensure appropriate use of medical services and resources. Develops and implements strategies to optimize the efficiency and effectiveness of medical utilization. Monitors and analyzes utilization patterns to identify opportunities for improvement.
2. Oversees medical case management to ensure efficiency and maintain compliance with company policies and standards, and government laws and regulations.
3. Works across CoreCivic Health Services and Operations enterprise to ensure timely scheduling of offsite medical visits.
4. Provides direction, guides and supports staff in the development of cost-effective care plans for high-risk, high-cost cases by working with healthcare providers.
5. Manages highly complex medical events to determine the appropriate standard of care. Ensures the resolution of complicated disputes of healthcare providers.
6. Monitors legal, industry and economic variables, assessing contracted rates to adjust to the strategic landscape.
7. Maintains understanding of Provider Contracting & Centralized Scheduling workflows. Identifies potential process improvements and supports the design and implementation changes as requested, leveraging on-site and leadership where appropriate.
8. Develops, reviews, and updates utilization management policies and procedures to ensure compliance with regulatory standards and best practices. Collaborates with clinical and administrative departments to ensure policies are effectively communicated and implemented.
9. Compiles, evaluates, and reports statistics and trends to team members, and utilizes the information to facilitate process improvement. Works with the Health Services Quality Team to identify and address areas for improvement in medical utilization and patient care. Develops and implement initiatives to enhance the quality and efficiency of healthcare services.
10. Supervises staff in the performance of their duties and evaluates as prescribed by company policy. This includes, onboarding new employees, evaluating performance and preparing written performance reviews, listening to concerns and effectively resolving problems or issues, taking corrective or disciplinary action, developing work schedules for staff and approving leave requests.
11. Leads performance improvement and evaluation processes related to the management of patient care across the continuum. Collects trends and analyzes aggregate outcome data for the population to be used in identifying best practices and targeting performance improvement efforts.
12. Monitors case management, utilization, and scheduling metrics and develops and implements business solutions to address process and quality gaps. Works closely with physicians, nurses, and other healthcare professionals to promote efficient use of medical resources. Serves as a liaison between the utilization management department and other clinical and administrative departments.
13. Domestic U.S. travel may be required.
QUALIFICATIONS:
Graduate from an accredited college or university with a Bachelor's degree in Nursing (BSN) is required.
Master's degree in Nursing preferred.
Five years of professional nursing practice experience required.
Demonstrated leadership and management skills with knowledge and application of case management, care delivery models, healthcare delivery systems, and CQI process experience required.
Certification from the American Case Management Association (ACMA) or Commission for Case Manager Certification (CCMC) is preferred.
Proficiency in Microsoft Office applications required.