Utilization Management Director, RN Required

🕒 April 17

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Northeast Georgia Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Northeast Georgia Health System is a healthcare organization dedicated to improving the health of the community it serves. With a presence that includes 5 hospitals, 6 urgent care locations, and more than 110 doctor's offices, imaging centers, cancer treatment centers, and laboratories, the system offers a comprehensive range of medical services. It provides career opportunities in various areas, including nursing, allied health, and support services, as well as residencies and fellowships for healthcare professionals. The organization is committed to its mission through adherence to core values, offering employee benefits, and engaging in community activities. With locations providing access to both metropolitan and natural amenities, it emphasizes quality of life for employees and residents in Northeast Georgia.

📋 Description

• Oversee day-to-day operations of the Utilization Management Department • Ensure compliance with payer requirements and regulatory standards • Monitor and analyze key performance indicators (KPIs) • Recruit, train, and manage a high-performing UM team • Manage departmental budgets and financial responsibility • Develop and implement performance metrics

🎯 Requirements

• Registered Nurse license • UR specific certification preferred (CCM, ACM, CPUR) • Bachelors Degree • Minimum of 7 years UR experience • 2 years progressive Revenue Cycle leadership experience • Proven ability to lead teams and manage budgets • Strong ability to educate and influence on UM best practices • Experience in data analysis and performance improvement strategies • Expertise in medical necessity criteria and payer regulations

🏖️ Benefits

• Health insurance • 401(k) retirement plans • Paid time off • Professional development opportunities