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Director Utilization Management

Requisition #

62910BR

Physical Location

Minneapolis, Minnesota

Posted Date

06-Jul-2020

Dept. Name

RCM-Administration

Hours Per Week

40

Contract

Noncontract

Introduction

Allina Health is dedicated to the prevention and treatment of illness and enhancing the greater health of individuals, families and communities throughout Minnesota and western Wisconsin. A not-for-profit health care system, Allina Health cares for patients from beginning to end-of-life through its 90+ clinics, 12 hospitals, 16 pharmacies, specialty care centers and specialty medical services that provide home care, senior transitions, hospice care, home oxygen and medical equipment, and emergency medical transportation services. Allina Health is a vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment to match your specific interests. We believe employees are our greatest asset and are dedicated to helping you develop and maximize your professional skills.

The Commons, located in Minneapolis, is the headquarters of Allina Health, a not-for-profit health care organization serving patients and communities. Approximately 1,600 corporate and administrative service employees work at offices within Midtown Exchange, the site of the historic Sears retail complex at Chicago Avenue and E. Lake Street. This community landmark, adjacent to the campus of Abbott Northwestern Hospital, part of Allina Health, is the second largest building in Minnesota and includes offices, an internationally themed public market and residential units.

 

Responsibilities

Req ID: 62910
Overview:

The Director of Utilization Management coordinates the design, development, implementation and monitoring of Allina Health’s utilization management function that emphasizes appropriate patient status as well as concurrent and retrospective review of care. The Director manages the day-to-day operations of the Utilization Management staff across all metro and regional hospitals. The Director is tasked with closely coordinating the utilization management function with the case management function within each metro and regional hospital. The Director serves on the RCM leadership team that collaborates to develop the RCM strategy, goals and metrics, and budget.

Strategy Responsibilities

Collaborate with VP Revenue Cycle Management to set clinical revenue cycle strategic goals and metrics
Collaborate with case management leaders to develop case management goals and metrics
Consult with physicians and other professionals to develop improved utilization of effective and appropriate services
Provide overall direction, design, development implementation and monitoring of utilization programs to meet Allina’s utilization goals while maintaining customer satisfaction.
Operational Responsibilities
Oversee the implementation of program to drives medical necessity and patient level of care based upon clinical guidelines and payer requirements / health plan benefit guidelines
Act as a resource to the medical staff, administrative staff and external regulatory agencies in all issues relating to utilization management
Responsible for operational oversight and performance of Utilization Review practices to ensure compliance with regulatory, contractual and accreditation requirements
Evaluate system-wide clinical guidelines and measures for utilization management and peer review to ensure that established procedures are followed, improvements are made when needed, and that clinical committees follow through with their responsibilities to improve utilization of effective and appropriate services
Collaborate with case management to ensure utilization management and case management roles, responsibilities, and goals are aligned to Allina Health’s strategic plan and vision
Ensure compliance with the established guidelines is continuously adhered to
Work closely with hospital leadership to ensure the standards and goals are met, and knowledge and best practices are shared system-wide
Ensure appropriate management and staffing levels to manage work flow and meet performance standards
Talent Management Responsibilities
Determine and communicate recruitment needs for utilization management sub-functions
Collaborate on the development & implementation of a RCM staff plan, including learning and development strategy, in collaboration with the relevant RCM leaders
Establish project priorities and program management resources allocation to align with RCM’s strategic plan, goals and objectives
Leadership Responsibilities
Anticipate and act on emerging healthcare trends to position the system and RCM for the future, in conjunction with other system and RCM leaders
Maximize existing talent by providing counsel, leadership, guidance and direction and assisting in the development of an organizational culture appropriate to support the mission of Allina Health and RCM. Employ participative management and leadership approaches that optimize organization resources, talent effectiveness and engagement. Empower others to exercise leadership in achieving goals, developing new concepts and taking initiative
Be a steward of the culture by demonstrating and modeling leadership behaviors
Promote, act and collaborate as a unified leadership team to drive system alignment towards the vision of RCM
Maintain a working knowledge of applicable Federal, State and local laws and regulations, Allina Health Compliance standards, Standards of Conduct, as well as other policies in order to ensure adherence in a manner that reflects honest, ethical and professional behavior
Establish a clear, reputable, personal brand, and serve to inspire colleagues
Encourage teamwork and teambuilding
Maintain a strong knowledge of healthcare policies and understand business impact on RCM
Identify key talent and develop leaders within the respective RCM sub-functions
Communicate clearly and persuasively to build support for initiatives, engaging RCM stakeholders and other relevant system stakeholders

Education

Bachelor of Science in Nursing required with a relevant Master's degree preferred

Qualification/Skills

10 years leadership experience in revenue cycle, case management, utilization review, or similar.
10 years Epic experience preferred
Experience in Revenue Cycle process; an understanding of Epic Systems Revenue Cycle system capabilities
Demonstrates knowledge and proficiency of standard PC word processing, spreadsheet, database and presentation applications (e.g., Word, Excel, Access, PowerPoint) to develop, prepare and analyze statistical reports
Requires the ability to communicate clearly and concisely, orally and in writing
Requires knowledge of medical terminology
Excellent project management, problem solving and analytical skills
Excellent verbal and written communication and interpersonal skills
Detail-oriented and independent worker
Requires an understanding of the role of CBO Operations within Revenue Cycle Management, and across the health system

Work Schedule

M-F

Location/Community Information

Minneapolis boasts being both cosmopolitan yet small enough that you can find a place to call home whether on a lake, golf course, or in an adjoining suburb. With the fast pace of activity there are professional sports, theater, or enough parks for a quiet walk. The area has numerous schools and colleges, both public or private, and enough teams for all weekend athletes to join.

  • Located in Minneapolis
  • Population = 380,000
  • Service Area = 2,882,245

Community Resource Links:

Community Information School Digger

Explore Minnesota MN Dept of Education

Minneapolis St. Paul MagazineSt. Paul Pioneer Press

Twin Cities Living MagazineStar Tribune


Closing

If you are interested in becoming part of our award winning team of professionals, please apply online today. Allina Health is committed to providing Equal Employment Opportunities to all employees and applicants. EO M/F/Disability/Vet Employer.


Requisition #

62910BR
Executive / Mgmt / Supervisory, Finance