Interim Director of UM

Curative has an exciting and unique opportunity to lead our medical Utilization Management team on an interim basis. This role is responsible for managing the activities of the Medical Utilization Management Department. Provides leadership in the development of a culture for quality care. Performs highly responsible management work in leading, developing, directing, and coordinating programs and functional activities. Establishes tools, processes, and systems to optimize clinical quality, patient safety and appropriate and timely access to care. Responsible for meeting turnaround times, measuring quality as well as identifying opportunities and strategies for clinical performance improvement. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Generates, implements and maintains the annual Utilization Management Program. Maintains staffing at a level adequate to meet the needs of our business, and provides consistent training, auditing, and feedback Consistently meets or exceeds standards regarding: Prior authorization requests (routine, urgent or emergent, etc.) Denials, appeals, and complaints Telephone statistical reporting Maintains Utilization Review Agency licensure Develops, monitors, and updates policies and procedures regarding utilization management programs in accordance with State and Federal law Responsible for identifying and implementing new technology to assist in the timely and accurate payment of claims (e.g., coding software, imaging and archiving solutions, etc.) Provides direction to staff in carrying out responsibilities; interprets laws, policies, operational procedures, and objectives; reviews operations in assigned area to ensure high level of quality is consistent with organizational standards. Responsible for collecting, analyzing, evaluating, and presenting utilization management data to a wide range of audiences. Promotes the effectiveness of support systems structure and infrastructure for assigned area of accountability. Performs operations analysis with appropriate follow-up action plan and intervention. Promotes decision-making in area of responsibility, utilizing processes and interactions promoting information analysis of all involved factors relative to corporate strategy and position. Applies Human Resources/Personnel policies per organizational procedure and serves as resource for the implementation of such policies and procedures; defines expectations for performance and holds subordinates accountable; sets goals and outcome parameters and defines operational parameters and expectations. Establishes planning processes in response to corporate strategy, goals, and objectives; monitors on a regular basis progress and accomplishments; promotes and coordinates program development through appropriate planning, analysis, and developmental phases. Collaborates with administration, management, and educational resources to develop mechanisms for educational advancement; facilitates methods for professional development consistent with the demands of the position in an effort to assure competency in assigned area of responsibility; plans strategy for development and ongoing educational needs; serves as mentor (coach and counsel) promoting professionalism on a group or individual basis. Directs the development of systems and mechanisms to monitor the effectiveness and improvement of professional interventions. Reviews department performance in relation to established goals, implementing changes to effect continual improvement in services provided; and ensures compliance with regulatory and legal requirements. Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc). This position assumes and performs other duties as assigned.