The incumbent has responsibility for developing, directing and coordinating the Departments of Utilization Management according to the policies and procedures and standard work that guides the operational and clinical issues for high quality, cost effective utilization management processes that support patient care while maximizing the revenue cycle. The incumbent shall plan, organize, direct and evaluate people and activities for the department to maximize authorizations, billing compliance and appeals. The incumbent has fiscal responsibility for resources that are defined during the budget process. The position is accountable for human and materiel resource acquisition, maintenance and allocation as well as quality/performance improvement outcomes. The position’s primary focus is on employees, Epic workflows, patient accounts and the key contributors from other departments who impact access, scheduling, authorization, billing and appeals. The success of the department depends significantly on the incumbent’s ability to collaborate with other leaders across the health system to develop and maintain systems that support patient care through utilization management and revenue cycle improvements.
Principal Duties and Responsibilities:
The Executive Director of Utilization Management reports to the Vice President of PFS, with matrix reporting to the entity CFOs of hospital services and is accountable for the direct oversight and management of the MHS inpatient and outpatient Utilization Management departments. The Executive Director is responsible for planning and developing new services, policy formation, human resource management and organization and regulatory compliance. The Executive Director develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operation functions and promotes quality cost -effective health care. The Executive Director uses Lean management systems and processes to continually strive toward performance improvement and development of high quality, cost-effective utilization management processes that support patient care while maximizing the revenue cycle. The Executive Director is also responsible for operationalizing reimbursement parameters via coordination with multiple department heads and Care Lines, Medical Staff, and per executive leadership, initiatives and the strategic plan. The Executive Director supervises and manages directors, managers, leads, and staff to coordinate the day to day operations of the department. The Executive Director has expertise in the IS systems used within the department.