Healthcare Partners, a leading network of healthcare providers and clinics in southern Nevada, has joined Intermountain Healthcare, a large regional organization considered one of the nations top health systems. Together, the two organizations will provide Nevada with a stronger, more comprehensive regional health system. Intermountain Healthcare is looking fora Medical Director of Utilization Management to join ourteam in Nevada.
This position interacts with utilization management, claims, network management, and finance. As the Medical Director, UM you are responsible for the appropriate utilization of medical services within established guidelines and for assuring that quality medical care is being delivered to our patients. In this role, you will develop, implement and administer policies and procedures for utilization of inpatient, ancillary, and specialty services throughout the care continuum. Must be knowledgeable of State and Federal regulatory agencies standard, related to health care organizations, which includes Medicare coverage criteria.
We offer competitive pay with financial incentives for yielding strong metrics on quality care. Our clinicians receive an excellent benefit package, including CME reimbursement, paid license renewals, generous PTO, and much more. Take advantage of personal and professional growth opportunities offered at Intermountain Healthcare, including leadership pathways, charitable sponsorships, and volunteer opportunities.
Our combined strengths and a shared cultural commitment as community-focused health systems with deep, personal connections to the people we serve allow us to focus on moving southern Nevada forward. Intermountain Healthcare is ranked in the top five of our nations health systems for quality, cost, and innovation, and brings 45 years experience in making care more accessible and affordable. If youre ready to join our Mission in helping people live the healthiest lives possible please apply now to submit your CV for consideration, or you may contact Anita Prince or firstname.lastname@example.org.
- Must have a demonstrated record related to case management, utilization management, quality management, discharge planning or other cost management program.
- Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Engages in peer to peer conversations to guide and support deliver of evidence-based care. This includes review of complex, controversial or experimental medical services.
- Five years in a professional setting such as hospital, clinic or home health environment.
- Strong analytical and problem solving skills
- Effective communication and interpersonal skills
- Contribute to and supports the corporations quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporations quality improvement efforts.
- Timely documentation and reporting
- Provide oversight in the following areas, ASC utilization management, ER/K management, and serve as the chair designated committees defined by the organization.
- Possess a strong progressive and customer-focused approach to building and maintaining customer and provider relations.
- Statistical and fiscal data collection and interpretation
- Schedule: Monday-Friday, 8 am-5 pm
- No Call
- Practice location Corporate Office
- Must have or be eligible to have a current and unrestricted Nevada medical license
- Minimum of 5 years work experience related to case management, utilization management, quality management, discharge planning or other cost management.
- Board Certified in Internal Medicine, Family Practice or other primary care specialty
- Current Nevada DEA certificate required prior to start date
- Current Nevada Pharmacy license required prior to start date
- BLS/ACLS certification prior to start date
OverviewHealthcare Partners, a leading network of healthcare providers and clinics in southern Nevada, has joined I...
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