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System Utilization Management Director

Job Description


Job ID: 1220012
Employment Status: Full-Time
More Information:

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.


Overview


Role Purpose

System Utilization Management Director leads and directs the utilization review staff and function for BJC HealthCare including organizing, directing, and controlling all internal operations of assigned clinical departments in Utilization Management/Review. Works in collaboration with medical staff, inpatient case managers and social work, patient access and pre arrival, and revenue cycle team to manage UM process for patients admitted to BJC hospitals. System Utilization Management Director implements standard processes e.g. timely payer reviews and notifications to ensure that the patient is getting the right care in a timely and cost-effective way.


Responsibilities

  • Manages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
  • Develops and adheres to departmental staffing, revenue and/or expense budgets. Responds to changes in the business which may affect the ability to achieve the budget goals.
  • Oversees creation and implementation of UM policies and procedures that incorporate best practices, ensure effective utilization review processes, and meet payer requirements.
  • Acts as a catalyst between the UM and related departments including patient access, case management, physician advisors, pre-arrival, HIM, and the denials and appeals team to ensure continuity and quality of service and care.
  • Develops and analyzes reports to identify significant utilization trends, patterns, and impacts on resource utilization that supports the work of HSO UM committees.
  • Develops strategies and specific objectives in collaboration with revenue cycle team to improve the utilization management sub-function leading to reduced denials and improved collections.
  • Establishes organizational structure to support efficient and effect operations across all BJC HSO Utilization Management functions. Manages UM budgets and staffing to ensure timely reviews and notifications are completed. Creates standard onboarding, staffing models, and coverage plans for the BJC UM operation.
  • BJC has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.

  • Minimum Requirements

     

    Degree

  • Bachelor's Degree
  • - Nursing/Healthcare related

     

    Experience

  • 5-10 years
  •  

    Supervisor Experience

  • 5-10 years

  •  

    Preferred Requirements and Additional Job Information

     

    Degree

  • Doctorate
  • Master's Degree
  •  

    Experience

  • 10+ years

  • Benefits Statement

    Note: not all benefits apply to all openings

    -  Comprehensive medical, dental, life insurance, and disability plan options
    -  Pension Plan*/403(b) Plan
    -  401(k) plan
    -  Tuition Assistance
    -  Health Care and Dependent Care Reimbursement Accounts
    -  On-Site Fitness Center (depending on location)
    -  Paid Time Off Program for vacation, holiday and sick time

    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Alton Memorial or Parkland Health Center


    Legal Statement

    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

     

    Equal Opportunity Employer