Director, Utilization Management
AHMC Healthcare
This is a Full-time position in Anaheim, CA posted November 16, 2021.
Overview
The Director of Case Management is responsible for the overall operations of Pre-Admissions, Case Management, Discharge Planning and Social Services at AHMC-ARMC.
This position is a liaison between medical staff and administration and is responsible for monitoring utilization processes, LOS, patient mix and outlier trends.
It also facilitates information sharing and problem resolution by maintaining cooperative relationships.
The position is accountable to County, State and Federal agencies as well as Joint Commission for maintaining compliance with all applicable laws, regulations and standards and for contributing to quality patient outcomes.
Qualifications
A minimum of five years of nursing experience in an n acute care hospital with a background in a broad range of service areas.
Business Administration experience and Bachelors in Nursing or Business Administration preferred.
5-7 years of utilization management in an acute hospital setting.
Management experience preferred.
Experience in the following arenas: developing/ assigning clinical pathways, identifying alternate plans and physician negotiations, coordinating the activities of the UM Committee, coordinating efforts of hospital, physician organizations, IPAs, etc for smooth resolution of problems, working knowledge of Milliman & Robertson and Interqual Criteria.
Working knowledge of contracts and payor/ patient mixes.
Excellent customer relation skills.
