Director, Utilization Management

Sentara Healthcare
Full Time
Glen Allen, VA 23060
Posted
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Job description

Sentara Health Plans is currently hiring an experiencedDirector, Utilization Management to work in our Optima Health plan office, VA Beach, VA (Remote) Required experience:Previous Management experience - 5 years minimum Nursing experience - 5 years minimum Required Education:Minimum Bachelor's level degree ORMSN - Master's in Science and Nursing ORDoctorate level nursing degreeWhat is expected:Provides leadership, education, and strategic direction for managers and clinical staff and clinical operations. Managing process and workflow changes related to areas of responsibility. Assumes responsibility and accountability for operations and success of assigned areas. Supports and facilitates continuous efforts to improve organizational and clinical performance. Ensures quality of care meets or exceeds regulatory standards and requirements as measured by the division clinical quality indicators. Provides leadership for all staff development functions. Ability to interact with a wide audience to implement change.

The Director of Utilization Management (UM) is responsible for providing oversight to the daily functions of the UM staff and monitoring staff performance in accordance with Health Plan policies and procedures. Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of the managed care members' performance across the continuum of care to include the complete transition of care to outpatient care. Leads special projects, reviews of UM programs, and evaluation of UM performance, as indicated by contract, regulatory and/or accreditation requirements. Collects, analyzes, audits and reports UM program trends and quality outcomes. Provides clinical and operational oversight of each UM initiative which includes analysis of clinical data to drive performance improvement. Develops, implements, and monitors policies and procedures for contract and accreditation compliance. Provides recommendations to senior leaders on healthcare strategies, product development, policy and procedure changes and/or cost control opportunities.
  • Registered Nurse License (RN) - North Carolina
  • Registered Nurse License (RN) - New Mexico - New Mexico
  • Registered Nurse License (RN) - New Jersey - New Jersey
  • Registered Nurse License (RN) - New Hampshire - New Hampshire
  • Registered Nurse License (RN) - Nebraska - Nebraska
  • Registered Nurse License (RN) - Montana - Montana
  • Registered Nurse License (RN) - Missouri - Missouri
  • Registered Nurse License (RN) - Mississippi - Mississippi
  • Registered Nurse License (RN) - Maryland - Maryland
  • Registered Nurse License (RN) - Maine - Maine
  • Registered Nurse License (RN) - Louisiana - Louisiana
  • Registered Nurse License (RN) - Kentucky - Kentucky
  • Registered Nurse License (RN) - Kansas - Kansas
  • Registered Nurse License (RN) - Iowa - Iowa
  • Registered Nurse License (RN) - Indiana - Indiana
  • Registered Nurse License (RN) - Idaho - Idaho
  • Registered Nurse License (RN) - Georgia - Georgia
  • Registered Nurse License (RN) - Florida - Florida
  • Registered Nurse License (RN) - Delaware - Delaware
  • Registered Nurse License (RN) - Colorado - Colorado
  • Registered Nurse License (RN) - Arkansas - Arkansas
  • Registered Nurse License (RN) - Arizona - Arizona
  • Registered Nurse License (RN) - Alabama - Alabama
  • Registered Nurse License (RN) - Other/National
  • Registered Nurse License (RN) - Wyoming - Wyoming
  • Registered Nurse License (RN) - Wisconsin - Wisconsin
  • Registered Nurse License (RN) - West Virginia - West Virginia
  • Registered Nurse License (RN) - Virginia
  • Registered Nurse License (RN) - Utah - Utah
  • Registered Nurse License (RN) - Texas - Texas
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  • Registered Nurse License (RN) - South Dakota - South Dakota
  • Registered Nurse License (RN) - South Carolina - South Carolina
  • Registered Nurse License (RN) - Oklahoma - Oklahoma
  • Registered Nurse License (RN) - North Dakota - North Dakota
  • Master's Level Degree
  • Bachelor's Level Degree
  • Nursing 5 years
  • Managed Care 5 years
  • Writing
  • Troubleshooting
  • Time Management
  • Technology/Computer
  • Systems Evaluation
  • Systems Analysis
  • Speaking
  • Social Perceptiveness
  • Service Orientation
  • Science
  • Reading Comprehension
  • Quality Control Analysis
  • Project Management
  • Persuasion
  • Monitoring
  • Microsoft Word
  • Microsoft Excel
  • Mgmt of Staff Resources
  • Mgmt of Material Resources
  • Mgmt of Financial Resources
  • Mathematics
  • Learning Strategies
  • Leadership
  • Judgment and Decision Making
  • Critical Thinking
  • Coordination
  • Complex Problem Solving
  • Communication
  • Active Listening
  • Active Learning

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