Group Director - Utilization Review

Benefit Statement

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.

Position Specific Responsibilities

• Develop and maintain procedure manuals for UM annual work plan/evaluation and quarterly and semi-annual UM reports
• Oversight of daily operations of the UM team and optimizing denial mitigation processes
• Partner with the Group DCM and Hospital Case Mgt. Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput
• Integrate national standards for utilization management supporting medical necessity and denials prevention

Qualifications

• Bachelor’s degree in business, nursing or health care administration required. Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred.
• A minimum of 5 years’ experience in hospital revenue cycle function. Five (5) years in hospital Utilization Review Leadership preferred. Multi-site leadership experience preferred. Experience successfully implementing centralized Utilization Review teams for multi-hospital system strongly preferred.
• Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six Sigma Green Belt preferred
• Working knowledge of CarePort and MIDAS documentation and reporting required. Project Management and Business Planning experience; strong analytical skills including use of Tableau and Excel; executive communication and presentation skills including ability to use PowerPoint.
• Valid Registered Nurse (RN) preferred

Physical Demands

• Lift/position up to 25 lbs. Push/pull up to 25 lbs of force.
• Frequent sitting. Moderate standing, walking, reaching, stooping, and bending
• Manual dexterity, mobility, touch, auditory to perform all the related duties of the position

About the Role

The Group Director, Utilization Review will support the advancement of Centralized Utilization Review as a leader, mentor, and consultant. Will execute on strategic initiatives and provide subject matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations.

Facility Description

The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women's Hospital, the DMC Heart Hospital, Huron Valley-Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital.

EEO Statement

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other 13 legally protected status.

Additional Information

• Tenet Physician Resources
• Conifer Health Revenue Management
• USPI Ambulatory Surgical Centers