Utilization Review Care Management Director

Job description

Job Description: Leader is responsible for providing leadership and administrative oversight to ensure effective coordination of patient services across multidisciplinary teams and throughout the continuum. Leader collaborates closely with Medical Staff, Nursing, Clinical Services, and Revenue Cycle leadership to promote high-quality patient care, achieve financial objectives, and support leadership development. This role is operationally responsible for a broad range of care management services, including complex care management, social work, transition planning, behavioral health, and care coordination. These services may be delivered in various settings, including acute care, emergency departments, ambulatory clinics, and home-based environments. Reporting to a member of senior leadership, this position is accountable for designing, implementing, and managing longitudinal care strategies that ensure seamless transitions across care settings. Leads initiatives and partnerships that ensure patients receive the right care, at the right time, from the right provider, in the most appropriate setting—optimizing health outcomes and cost-effectiveness. Leader may be required to travel to locations across the enterprise. Essential Functions Oversees strategic planning, day-to-day operations, and standards of care. Promotes efficient, fiscally responsible, effective, safe, and compassionate care. Accountable for fiscal management, including budget development, cost center analysis, and ongoing monitoring to ensure alignment with organizational goals. Models professionalism and fosters a supportive environment. Leads workforce planning efforts focused on recruitment, retention, staffing, development, and succession planning. Oversees human resource functions including interviewing, hiring, onboarding, training, and performance management which may include corrective action and termination. Facilitates coordinated clinical and non-clinical care in collaboration with interdisciplinary teams and providers to enhance patient outcomes. Partners with physicians to achieve clinical, operational, financial, and service excellence. Ensures processes and programs support patient satisfaction and service quality goals. Builds community relationships and promotes the integration of community resources to enhance the overall patient experience. Ensures compliance with regulatory agencies regarding discharge planning, conditions of participation and care management. Skills Care Management & Social Work Leadership & Strategic Planning Patient Satisfaction Nursing & Care Coordination Budgeting Communication People Management Collaboration Community Outreach Regulatory Requirements Minimum Qualifications Current Registered Nurse (RN) license or Licensed Clinical Social Worker (LCSW) license in state of practice. Bachelor of Science in Nursing (BSN) OR Master of Social Work (MSW) from an accredited institution (degree verification required). Care Management Certification within 24 months of hire or promotion. Demonstrated management experience in Care Management or related area. Demonstrated experience in hospital or ambulatory case management, social work, or related areas requiring knowledge of the current healthcare environment, healthcare regulatory matters and healthcare reimbursement. Demonstrated knowledge and oversight of government regulations, contractual requirements, and NCQA accreditation standards. Preferred Qualifications If an RN, Master of Science in Nursing (MSN) from an accredited institution must be obtained within four (4) years of hire or promotion. Professional experience working in an integrated delivery system that includes a health plan. Experience in directing other clinical areas, collaborating with physicians, and developing clinical strategies, implementing operational efforts, and measuring outcomes. Experience evaluating technology solutions to support care management functions. Experience with developing collaborative relationships with payors to address healthcare needs across the continuum. Experience in a role requiring strategic thinking and planning skills and the ability to develop proposals, pilots, and projects from conception to implementation. Physical Requirements Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. May have the same physical requirements as those of clinical or patient care jobs when the leader takes clinical shifts. For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing, and reading signs, traffic signals, and other vehicles. With this position, you are eligible to participate in the Annual Pay for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity. The AP4P award opportunities are calculated as a percentage of your base salary. Awards are paid out based on attainment of selected Board-approved goals. To show our commitment to you and to assist with your transition into our organization, we also may offer a sign-on and / or relocation when applicable. Location: Intermountain Health McKay-Dee Hospital Work City: Ogden Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $59.50 - $91.84 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here . By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.