Director Case Management and Utilization Review
Apply NowCompany: Loretto Hospital
Location: Chicago, IL 60629
Description:
The Director of Case Management and Utilization Review is responsible for overseeing the efficient and effective management of patient care services, ensuring the appropriate use of healthcare resources, and optimizing patient outcomes. This role leads a team of case managers and utilization review specialists, developing strategies to assess and enhance the quality of care, promote continuity of care, and improve patient satisfaction. The Director collaborates with clinical staff, healthcare providers, and administrators to ensure adherence to policies, procedures, and regulatory standards while managing the utilization of healthcare services to reduce unnecessary costs. This position requires a strategic mindset, a strong understanding of clinical practices, and expertise in healthcare management and patient care coordination.
Key responsibilities include developing and implementing case management programs, conducting utilization review processes to ensure appropriate resource allocation, ensuring compliance with insurance and regulatory requirements, providing staff training and development, and fostering a collaborative approach across departments. The Director will also play a critical role in analyzing performance metrics, identifying areas for improvement, and driving initiatives aimed at enhancing care delivery and operational efficiency.
JOB REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Registered Nurse with current license or Bachelor's Degree in Health Administration related field.
2. At least five years progressive experience in utilization management, discharge planning and/or case management.
3. Exceptional communication and leadership skills, demonstrates good work ethic, and analytical skills
4. Extensive knowledge of community resources.
5. Demonstrates considerable knowledge of payor requirements and criteria sets.
6. Extensive knowledge of regulatory requirements, including but not limited to, JCAHO, IDPH and CMS.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Job Duties" are essential job functions.
PHYSICAL DEMANDS:
While performing the duties of this job, the employee is frequently required to sit, stand and walk as well as occasionally stoop, kneel, crouch or crawl. Using proper body mechanics, the employee may be expected to lift, pull, push or move patients and/or equipment. Fine motor skills are required when using hands and fingers to handle, feel or reach. Normal or corrected vision, hearing and ability to speak are necessary. Specific vision abilities required include close vision, sharp eye focus and ability to distinguish colors. There will be periods of stressful intense concentration with more than average pressure used in a variety of problem-solving situations.
Key responsibilities include developing and implementing case management programs, conducting utilization review processes to ensure appropriate resource allocation, ensuring compliance with insurance and regulatory requirements, providing staff training and development, and fostering a collaborative approach across departments. The Director will also play a critical role in analyzing performance metrics, identifying areas for improvement, and driving initiatives aimed at enhancing care delivery and operational efficiency.
JOB REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Registered Nurse with current license or Bachelor's Degree in Health Administration related field.
2. At least five years progressive experience in utilization management, discharge planning and/or case management.
3. Exceptional communication and leadership skills, demonstrates good work ethic, and analytical skills
4. Extensive knowledge of community resources.
5. Demonstrates considerable knowledge of payor requirements and criteria sets.
6. Extensive knowledge of regulatory requirements, including but not limited to, JCAHO, IDPH and CMS.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Job Duties" are essential job functions.
PHYSICAL DEMANDS:
While performing the duties of this job, the employee is frequently required to sit, stand and walk as well as occasionally stoop, kneel, crouch or crawl. Using proper body mechanics, the employee may be expected to lift, pull, push or move patients and/or equipment. Fine motor skills are required when using hands and fingers to handle, feel or reach. Normal or corrected vision, hearing and ability to speak are necessary. Specific vision abilities required include close vision, sharp eye focus and ability to distinguish colors. There will be periods of stressful intense concentration with more than average pressure used in a variety of problem-solving situations.