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Indiana University Health

Director-Health Plan Utilization Management

IU Health Plans
Date Posted
04 February, 2022
Schedule & Shift
Full Time
Day
Requisition Number
324703
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Director-Health Plan Utilization Management

Job Description

Overview

The Director of Health Plan Utilization Management provides leadership and strategic direction for throughput initiatives and outcomes for Health Plan Utilization Management (UM). Partners with the Vice President of Medical Operations (VPMO) and the throughput medical director on all related initiatives and is accountable for the development of effective UM practices, policies, and procedures to effectively manage UM operations. Works collaboratively with the VPMO to develop the UM program description, UM work plan and UM program evaluation to comply with all UM regulatory requirements and NCQA standards. Responsible for the efficient and purposeful integration of services with other areas and emerging delivery systems. Develops significant knowledge of hospital and physician reimbursement, payer contracts, and health industry trends, including Medicare and Medicaid to manage member's care in accordance to benefit and medical necessity guidelines. Works with the VPMO, physicians, and facility leadership to ensure the most appropriate care is provided in the most cost-effective settings to improve member outcomes. Is proficient in benefit administration, denial management and medical necessity criteria to effectively administer the UM program structure. Serves as a resource for staff/managers for development of cost reduction and throughput strategies. Collaborates with VPMO to establish appropriate service or clinical direction.

Qualifications/Skills/Knowledge:

  • Bachelor's Degree in a clinical field required, Master’s Degree preferred.
  • Licensed clinician required
  • Minimum of 5 years of related experience, with a minimum of 3 years of outpatient UM experience with payer.
  • Requires the ability to plan and manage the utilization of resources.
  • Requires knowledge of state and national regulatory agency guidelines.  
  • Requires the ability to lead quality improvement initiatives.
     

Reports to: Vice President- Medical Operations Health Plans

 

Indiana University Health is unlike any other healthcare system and we're looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People motivated to do their best every day. People who are always ready to apply themselves. As one of Indiana's largest employers, our vision is to lead the transformation of healthcare through quality, innovation, and education, and make Indiana one of the nation's healthiest states.

IU Health is among the top ten largest single-state nonprofit health systems in the United States. Through its 16 hospitals (a mix of urban, suburban, and rural facilities), IU Health offers a full range of specialty and primary care services for children and adults. Statewide, IU Health has more than 2,600 staffed beds, $6.23 billion in net total operating revenue, and strategic service lines including cancer, cardiovascular, neuroscience, orthopedics, pediatrics and transplant, that have received national recognition for quality patient care over the decades. IU Health has over 34,000 team members.

 

We are an equal opportunity employer and value diversity and inclusion at IU Health.  IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status, or any other characteristic protected by federal, state, or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

 

Apply teamwork. Apply experience. Apply skill. Apply yourself. And together we can change everything.

 

Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. As a condition of employment, IU Health requires all new hires to receive various vaccinations, including the influenza and COVID-19 vaccines, barring an approved exemption. New hires will also be provided the option to submit proof of previous vaccination.

We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

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Indiana University Health is Indiana’s most comprehensive health system, with 16 hospitals and more than 34,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.

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