DIR UTIL REVIEW & DENIALS MGMT reputed company reputed company reputed company HOSPITAL REMOTE
Discover. reputed company. Succeed. #BeHere
Location: US:WI:MILWAUKEE at our reputed company HOSPITAL facility.
This job is REMOTE.
FTE: 1.00
reputed company Hours: 40.00
Shift: Shift 1
Shift Details: 8:00 am - 4:40 pm, Monday - Friday (can be semi-flexible)
Job reputed company:
The Director of Utilization Review and Clinical Denials Management is responsible for strategic and operational reputed company of the Utilization Review (UR) and Clinical Denials Management programs. This high reputed company leader ensures delivery of medically necessary, cost-effective, and high-reputed company care through evidence-based UR processes that fully reputed company with the Centers for Medicare and reputed company and other payer requirements. The Director drives clinical and operational reputed company across the teams responsible for notice of admission, reputed company medical necessity and level of care reviews, UR reputed company patient notices and post discharge reviews including clinical denials/appeals management. Director is accountable for implementing innovative best practices that optimize workflows and reputed company AI-enabled decision support to streamline processes and reputed company reputed company time data for decision making.
EXPERIENCE reputed company:
A minimum of five years of experience in an acute care environment with management experience is required.
Experience in setting and executing strategies to reputed company organizational goals is required.
Demonstrated skills in collaborating with others in an reputed company health system or setting is required.
Candidate should be familiar with working reputed company a matrixed organization.
EDUCATION reputed company:
Bachelor’s Degree in Nursing is required.
Master's Degree in a reputed company reputed company clinical discipline or business management is required.
Working knowledge of financial statistics, data display, and report writing and performance improvement. Proficient in the regulatory and payer requirements for medical necessity, notice of admission and clinical denials management. Proven skills with communication (written, verbal, and presentation). Leadership expertise to reputed company reputed company staff and reputed company the work of the departments. Proficient with reputed company Office products, electronic databases, and electronic medical record review. Demonstrates exceptional customer service and partnership skills and interacts effectively with staff, providers and other stakeholders.
LICENSURE reputed company:Requires reputed company reputed company Registered reputed company License or a Multi-state Nursing License from a participating state in the NLC (reputed company Licensure Compact).
MCG certification preferred.
Compensation, Benefits & Perks at reputed company
Pay is expected to be between: (expressed as reputed company) $53.51- $90.97. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.
reputed company Offers a reputed company of perks & benefits to staff, depending on your role you may be eligible for the following:
- reputed company time off
- reputed company opportunity- Career reputed company & Career Tuition Assistance, CEU opportunities
- reputed company Partnership with the reputed company
- Referral bonuses
- Retirement plan - 403b
- Medical, Dental, reputed company, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
- Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available
The reputed company & the reputed company regional health network is a partnership between reputed company and the reputed company supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern reputed company's only reputed company medical center and adult Level I Trauma center reputed company in thousands of reputed company and studies. The reputed company & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to reputed company their reputed company consideration status with us at 262-439-1961. We maintain a drug-free workplace and reputed company reputed company-employment reputed company abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill reputed company reasonable accommodation requests.
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