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Every member of our senior management team is expected to obtain designation as a Certified Correctional Health Professional (CCHP) from the National Commission on Correctional Health Care.

Statewide Utilization Management - Director-RN Job



Job Number: 72081096433

Location: Columbia, MD

Date Posted: 8-15-2016

 

Wexford Health Sources, one of the nation's leading innovative correctional health care companies, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality.  For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.

At Wexford Health our philosophy is that health care should not be considered a luxury for anyone.  We simply care for those in need and the corrections environment is our venue.

Wexford Health has an exceptional opportunity for a Full Time Registered Nurse as our Statewide Director of Utilization Management to join our team of healthcare professionals at the Regional Office in Columbia, Maryland.

 We’re proud to offer a competitive benefits package including:

  • Annual review with performance increase
  • Generous paid-time off program that combines vacation and sick leave
  • Paid holidays
  • Comprehensive health insurance through Blue Cross Blue Shield
  • Dental and Vision insurance
  • 401(k) retirement savings plan
  • Company-paid short-term disability
  • Healthcare and dependent care spending account

POSITION SUMMARY

The Director of Utilization Management is responsible for the oversight, direction, and budget management of the Utilization Management (UM) Department; work closely with the Director of Operations and Statewide Medical Director of UM to ensure timely and accurate reviews that result in medically necessary, appropriate, efficient, and cost effective healthcare services (joint leadership model); ensure that all UM contract requirements are met; and we are a responsive and innovative partner for all clients.

DUTIES/RESPONSIBILITIES

  1. Keep the Corporate Director of Utilization Management; Maryland Director of Operations and Maryland Utilization Management Medical Director up-to-date concerning all UM issues;
  2. Provide oversight and supervision to the UM Department (UM Nurse and Schedulers);
  3. Assess assignments, proficiency, and productivity of UM staff;
  4. Ensure all new hire and existing employee are properly trained;
  5. Coordinate all processes with Corporate Medical Director of UM;
  6. Ensure UM policy and procedure compliance;
  7. Ensure all IP, ER, Collegial, and service completion processes meet client and contract expectations;
  8. Communicate and resolve issues with client/all departments, operations, and correctional facilities;
  9. Manage the interviewing, hiring, coverage, on-call rotation, performance/performance improvement, and termination processes of Maryland’s UM staff;
  10. Oversee all business development initiatives and oral presentations;
  11. Monitor all quality of care/risk management issues;
  12. Oversee claims resolution referral process;
  13. Ensure accuracy and timeliness of all daily reporting requirements and work with IT to create new reports;
  14. Oversee the appropriate use of InterQual, Milliman (MCG) Healthcare Management Guidelines, and Expert Panel Consultation;
  15. Ensure all UM Process Improvement Project initiatives continue to be met;
  16. Ensure weekly compilation and distribution of UM statistics and reports; and
  17. Ensure at least bi-weekly management communications meetings are occurring

ADDITIONAL DUTIES AND RESPONSIBILITIES

  1. Ensure monthly compilation and distribution of UM statistics and reports;
  2. Ensure monthly management and internal quality peer review audits are completed and reviewed;
  3. Ensure compliance with documentation to support BPAMs;
  4. Cooperate with UM Process Improvement External Auditors;
  5. Assist with updates to the UM Policy and Procedure/WexCare manuals;
  6. Participate in Corporate New Management UM training for correctional facilities; and
  7. Work on special projects as assigned by Senior Management

The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.

ENVIRONMENTAL CONDITIONS

Standard medical setting within a correctional facility, which includes daily interfacing with offenders/patients, correctional staff, and health care personnel.  Temperature extremes may be encountered while moving throughout the facility outdoors and indoors in buildings without air conditioning.


 

TRAVEL: Travel throughout the state is probable.

LICENSING: Current unrestricted Maryland RN license required

CERTIFICATION: Current CPR certification.

EDUCATION:

  • Graduate of an accredited nursing program with Bachelor’s Degree required;
  • Master’s Degree in Nursing or other related field preferred
  • Knowledge of word processing and spreadsheet programs.

PREFERRED EXPERIENCE:

  • Five (5) years of professional nursing experience including at least three (3) years of professional supervisory or administrative experience, preferred
  • Minimum 5 years in the practice of Utilization Management/Case Management in a Hospital or Managed Care setting
  • Utilization Management/Case Manager certification preferred

OTHER PREFERRED KNOWLEDGE, SKILLS AND ABILITIES:

  • Strong interpersonal and communication skills (verbal & written)
  • Willingness to work using a multi-disciplinary approach
  • General math and analytical skills, and planning, administrative and organizational skills essential.
  • Demonstrated experience maintaining multiple deadlines.  Must ensure documents are ready for review well in advance of any deadline.
  • Ability to competently manage multiple priorities simultaneously.
  • Ability to work in a stressful environment
  • Ability to assist staff with various policies, administrative and organizational projects.

EOE/M/F/D/V

 


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