The Director of Utilization Management reports to the System Director of Care Management and in partnership with the CHRISTUS Clinical Excellence Division and other health system leaders, is responsible for assisting in the creation and delivery of strategies focused on improving operations in the pursuit of clinical excellence. The incumbent will do so by participating in evaluation, planning and execution of the full scope of Utilization Management functions and improvement opportunities to form a comprehensive model of care across the continuum of health care services. He or she will work collaboratively with hospital Case Management Directors to evaluate, design, and implement strategies to enhance utilization review and physician advisor functions and evaluate outcome measures associated with each initiative. These strategies will directly impact quality, cost efficiency, and improve patient care.Â
Build strong relationships throughout the multi-hospital system to help support and maintain consistency with system-wide initiatives.
Translates organizational goals into action plans with outcome metrics for assigned department(s); Implements initiatives to meet strategic expectations.
Implement a high-reliability approach to reduce wasteful variation in practice and eliminate the consumption of unnecessary clinical resources while improving clinical and financial outcomes across the care continuum
Works collaboratively with system, regional, and entity leaders and physicians to develop and implement best practices for Utilization Management teams and programs that maximize appropriate resource utilization and physician advisor services.
Work collaboratively with hospital Case Management leaders and physician advisors to meet strategic and operational excellence goals including cost initiatives, and delivery of high-quality outcomes.
Guides teams in compliance with state and federal regulations.
Develops and oversees the execution of policies and procedures that direct the practices and workflow of the utilization review and physician advisory functions.
Implements plans to minimize clinical denials by working collaboratively with key partners in the system office, regions, and health system.
Implements strategies to consolidate and standardize utilization review efforts and models across the health system to positively impact length of stay, observation utilization, denials, physician advisor engagement, peer to peer reviews, and related metrics.
Assists teams in evaluation and implementation of technology to enhance the work of utilization review.
Works in partnership with the Managed Care team to streamline and enhance communication, and collaborate to improve working relationships with payors.
Assists in leading the Care Management Operations Council and health system Care Management Council as needed and provides leadership support for the committees and members of the group.
Direct supervision of utilization review functions as assigned.
Direct supervision of program director, utilization management.
Bachelorâ€™s Degree in nursing or social work required
Licensed as a RN or LMSW required
Masterâ€™s in healthcare or business-related field preferred
ACM or CCM certification preferred
Minimum of 5 years of hospital case management and utilization review experience.
Minimum of 3 years of hospital case management/utilization review leadership experience. Multiple site experience preferred.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.