Director-Enterprise Hospital Utilization Management

  • Regions Hospital
  • St Paul, MN, USA
  • Jan 05, 2021

Job Description

Job Description: At Regions Hospital you’ll find a warm, diverse group of people who are committed to helping our patients – and each other. We foster an inclusive environment that encourages new ways of thinking, celebrates differences and recognizes hard work. We’re also committed to living our values. This means you can expect us to be your partner and treat you with dignity and respect. Join our team and make good happen! Regions Hospital has an exciting new job opportunity available for an experienced leader as a Director-Enterprise Hospital Utilization Management. In Dyad partnership with the Enterprise Hospital Utilization Management/Physician Advisor Medical Director, the Hospital UM Director, has responsibility for oversight of the development, implementation and performance management of the Hospital UM Program across the HealthPartners family of care hospitals. The Director is responsible for defining and leading hospital utilization management strategy and optimization to develop and implement standardized utilization review services, to facilitate appropriate level of care determinations, optimize utilization of Physician Advisors, UM tools and resources, and prevent payer denials. This position will oversee the selection, implementation and ongoing performance of AI software specifically. The Director also collaborates with enterprise leaders of Revenue Cycle, hospital CFOs and Payer Relations/Contracting to address root cause for denials and manage prevention and appeals processes. The Director serves as the lead with representing UM work with hospital clinical operations, Care Management, Clinical Documentation Improvement, Revenue Cycle teams on all relevant improvement efforts, including level of care, LOS and denial management/prevention initiatives. The Director serves as a contributing member of relevant enterprise wide hospital committees to support management of key measures including level of care, length of stay, patient throughput and compliance metrics. Together with the Medical Director Physician Dyad, develops required individual hospital Utilization Review Committees and ensures compliance with requirements. Requirements include: Masters degree in healthcare-related field, business, quality management, health care administration, informatics or statistics. Minimum of 5 years relevant hospital experience in the field with demonstrated success in leading and collaborating with various clinical disciplines: physicians, nurses, social workers and other clinicians. Minimum of 5 years of hospital or health care leadership is required; 7 to 10 preferred. Experience and knowledge of health care financial management and operations; preferred specific experience in utilization management finance and revenue cycle interdependencies. Experience working across departments and organizations strongly preferred. Experience successfully implementing programs or services for multi-hospital systems strongly preferred. Enterprise experience in leading work and/or people/teams toward standard practice and operations Project management and business planning experience required; in hospital or healthcare setting preferred Valid and current discipline license in state of Minnesota as required for individual’s discipline Additional Information: We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.


M-F Days

Employment Type (feed only)