Utilization Management Program Director

2 weeks ago

Toronto, Ontario, Canada HealthEcareers - Client Full time
Job Summary:
As a key member of the HealthEcareers - Client team, the Utilization Management Program Director will oversee the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. This role requires a strategic thinker who can ensure cost-effective and quality patient care by optimizing resource utilization. The ideal candidate will provide direction to staff, collaborate with multidisciplinary teams, and manage member care across the continuum.

Key Responsibilities:
  • Develop and maintain policies and procedures for the Service Area or Medical Center related to Utilization Management.
  • Collaborate with multidisciplinary teams to plan and coordinate care across the continuum.
  • Manage member care with non-KFH hospital facilities and providers, identifying risk management and quality of care issues.
  • Provide direction to staff regarding utilization review, care coordination, discharge planning, and other services.
  • Conduct statistical studies on utilization trends, patterns, and outcomes.
  • Hire, train, and coach professional and clerical support staff.

Requirements:
  • Minimum three (3) years of experience in utilization management and discharge planning in an acute care setting, with supervisory or management experience.
  • BSN or bachelor's degree in a healthcare-related field, such as management or health services administration.
  • Registered Nurse License (California).

Preferred Qualifications:
  • Demonstrated knowledge of operations and healthcare management, including TJC, Title XXII, Medicare, MediCal, and other local, state, and federal regulations.
  • Knowledge of managed care operations.
  • Demonstrated interpersonal, negotiation, and management skills.
  • Good oral and written communication skills.

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