Director of Utilization Review and Care Management

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Directs the Clinical Resource Management department to include the Utilization Management (UM) plan and associated programs to impact resource management and compliance of all state, federal and accreditation requirements.
 

Minimum Specifications
 

Education

• Must have a Bachelor’s degree in Nursing, Health Administration, Public Health or Business Administration.

Experience

• Must have eight years of progressively responsible experience in a hospital or health program to include five years of leadership experience in Utilization Review or Care Management.

Equivalent Education and/or Experience

• None

Certification/Registration/Licensure

• RNs Only: Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
• RNs Only: Must maintain current healthcare provider CPR course completion card.
• Must have current healthcare provider BLS for Healthcare Providers certification from one of the following:
  • American Heart Association
  • American Red Cross
  • Military Training Network
     

Required Tests for Placement

• None

Skills or Special Abilities

• Must demonstrate understanding and use of statistics.
• Must demonstrate ability to navigate and master proprietary software programs.
• Must demonstrate ability to read and interpret documents.
• Must have excellent verbal and written communication skills and writing skills to include good grammar.
• Must have strong analytical skills.
• Must demonstrate ability to use a personal computer including knowledge of Microsoft office products.
• Must have effective leadership skills and be capable of motivating, recruiting and educating staff.
• Must be able to demonstrate knowledge of Parkland policies, structure, procedures and mission within three months of employment.
• Must demonstrate patient centered/patient valued behaviors.
   

Responsibilities

1. Directs the day-to-day activities of Utilization Review and Care Management departments, to include the Utilization Management plan, to ensure effective and efficient operations and completion of all required functions and tasks with a focus on a customer service oriented work environment which meets the needs of staff, providers and patients.
2. Serves as the subject matter expert for the Utilization Management (UM) plan and as an advisor to the medical staff on resource management processes.
3. Works closely with the medical staff, Chief Medical Officer, Physician Advisors, and Care Coordination to appropriately manage resource utilization at Parkland.
4. Works closely with the data analytical team in the development of necessary reporting for Clinical Resource Management and effectively measures key outcomes.
5. Responsible for effective fiscal management of the department. Prepares the annual budget, incorporating Parkland and Clinical Resource Management department goals. Periodically analyzes revenue and losses, revising budget, staffing, billing, facility access or other practices to accommodate cost effective findings. Ensures informed use of department resources through clear policies including equipment, supplies, personnel hiring/training practices and service utilization. Administers the operating, capital and payroll budgets to ensure that the department has the necessary funds to carry out the goals and objectives that have been established for the department. Complies with departmental budget requirements to control spending and develop the annual budget request.
    

Job Accountabilities

1. Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.