CommonSpirit Health

Director Utilization Management

CommonSpirit Health • $110K — $130K *
Houston, TX 77084In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
  • Minimum 3 years of clinical case management experience (Utilization Management, Denial Management, Care Coordination).
  • 5 years of management experience with increasing responsibility.
  • Extensive operational experience in managed care, including program planning and implementation.
  • Comprehensive knowledge of utilization management and financial management, including revenue cycle and compliance with Medicare and Medicaid.

Responsibilities

  • Lead the development and implementation of the Utilization Management Program.
  • Oversee staff to ensure operational performance standards are met or exceeded.
  • Collaborate with Division Director on strategies for departmental goals.
  • Manage payer requirements and address denial challenges effectively.
  • Direct accreditation activities and ensure compliance with regulations.
  • Review and analyze UM program outcomes and quality metrics.

Benefits

  • Opportunity to work in a prestigious academic medical center.
  • Access to a collaborative environment focused on innovative healthcare solutions.
  • Involvement in a comprehensive Care Coordination model.
  • Potential for career advancement in a reputable organization.
  • Contributory role in shaping Utilization Management practices in a top-tier facility.
Full Job Description
Job Summary and Responsibilities

The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops strategies to achieve departmental and CommonSpirit Health goals and objectives. This position directs the UM staff to meet or exceed operational performance standards. The Director oversees development and implementation of UM policies, procedures and processes; directs and assists with accreditation activities; efficient management of payer requirements, addressing denials effectively, and compliance with payer and regulatory requirements, and reviews and analyzes UM program outcomes and quality metrics.

Job Requirements

Required: 

  • Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
  • Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination)
  • 5 years of progressively responsible management experience 
  • Extensive operational experience in managed care; extensive experience in program planning, implementation, staffdevelopment, and needs assessment
  • Comprehensive knowledge of utilization management, financial management that includes revenue cycle, Medicare, Medicaid,and commercial admission and review requirements.
Where You’ll Work

Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

About CommonSpirit Health

CommonSpirit is a nonprofit health care center. They offer community health programs, research programs, virtual care services, and home health programs that address the root causes of poor health, such as access to care, affordable housing, neighborhoods, and a healthy environment.

CommonSpirit Health Careers

Join the dedicated team at CommonSpirit Health, a leader in healthcare innovation and community wellness. CommonSpirit Health offers a range of job opportunities that empower professionals to grow their careers in a supportive and diverse environment.

Explore Career Opportunities

CommonSpirit Health is actively hiring and offers a variety of positions that cater to different skills and career aspirations. From clinical roles to administrative positions, the company provides a platform for growth and professional development.

Experience a Culture of Care and Innovation

At CommonSpirit Health, the culture is grounded in diversity, leadership, and innovation. The team is committed to fostering an inclusive environment where every member’s contribution is valued. CommonSpirit Health leads with a spirit of compassion and a commitment to excellence in healthcare.

Join a Team That Values Diversity and Leadership

CommonSpirit Health believes in the power of diversity and leadership to drive innovation. The company invests in diversity training and leadership development programs, ensuring that all team members are equipped to lead with integrity and empathy.

Internship and Employment Opportunities

For those starting their career, CommonSpirit Health offers internship programs that provide hands-on experience in the healthcare industry. These internships are designed to develop essential skills and offer insights into various aspects of healthcare operations.

Benefits and Growth

Employees at CommonSpirit Health enjoy a comprehensive benefits package that supports both their professional and personal lives. The company is committed to the career growth of its employees, offering numerous opportunities for advancement and professional development.

Networking and Professional Development

CommonSpirit Health encourages networking and continuous learning. Employees have access to a wide range of professional development courses and are encouraged to connect with peers and leaders within the industry to enhance their career prospects.

Applying for a Position

To apply for a position at CommonSpirit Health, candidates should prepare their resume to highlight relevant experience and skills. The hiring process may include an interview to assess compatibility with the company’s values and culture. Interested candidates can explore job listings and submit applications through the CommonSpirit Health Careers portal.

Stay Connected with CommonSpirit Health Jobs

Keep up to date with new job opportunities and company news by subscribing to job alert emails from CommonSpirit Health. Tailor the subscription to receive updates that match specific career interests and preferences.

Explore CommonSpirit Health Careers

Discover the rewarding career opportunities at CommonSpirit Health. With a commitment to community health, innovation, and compassionate care, CommonSpirit Health is an ideal place to advance a career in healthcare. Search open positions that match skills and interests and join a team that’s making a difference.

SEARCH COMMONSPIRIT HEALTH JOBS

Read Careers Blog

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Learn more about CommonSpirit Health
Size
10,001 employees
Industry
Hospitals & Medical Centers
* Ladders Estimates

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