Assistant Director, Utilization Review

Job Title

Position Summary

The incumbent will be responsible for leading and assessing appropriate utilization of resources accomplished through efforts that are cost effective, safe, clinically appropriate, and enhance quality of care. Promotes and facilitates appropriate admission status, and facilitates movement through the healthcare continuum by implementing processes that ensure timely and proactive care coordination and discharge planning. Integrates department services with other departments and medical staff initiatives.

This will include implementation of procedures consistent with the goals and objectives of the Health System. The duties and responsibilities are established to assure efficient Utilization Management and Discharge Planning and staff productivity processing that directly affects UI Health's financial status. Expert knowledge of internal and external staff productivity modalities and positive communication with medical and house staff & UI Health personnel will assist in assuring success Duties & Responsibilities

• Collect and analyze length of stay data. Develop useful reports related to Transitions of care, LOS, denials, initial and concurrent reviews, and initial authorization among other areas
• Supervise and audit initial and ongoing medical records as required by CMS Conditions of Participation
• Attend daily huddles, weekly Clinical High Risk rounds, and support staff and multiple departments and nursing units with throughput and discharge barrier elimination
• Trains, orients, coaches, evaluates effectiveness and competence of staff to promote safety and quality
• Assist the Director with training, supervising, and developing staff to provide quality and efficient utilization review and discharge planning services to UI Health patients
• Collect and analyze data for staff productivity. Develop reports that track departmental goals. Evaluate effectiveness and adequacy of procedures, quality, and recommend and implement modifications (CQI).
• Ensures compliance with recommendations and requirements from external agencies such as accreditation, certification/licensing and other regulatory bodies.
• Assist Director with assigning staff duties and functions as departmental contact in the absence of the Director.
• Function as staff preceptor and resource person. Provide excellent customer service and model leadership
• Perform other related duties and participate in special projects as assigned.

Qualifications

Minimum Qualifications

• Bachelor's Degree in Nursing required
• Current license as a Professional Registered Nurse from the State of Illinois required.
• Minimum of five (5) years Utilization Management and Discharge Planning experience required.
• Proficiency in Data Analysis and training experience.
• Knowledge of Payer Reimbursement Processing

Preferred Qualifications

• Supervisory experience preferred.
• Preferred candidate has experience working with both providers and payor sources.

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.