Director, Utilization Management
Location: Jackson Mississippi
Description: Qualis Health is currently seeking to employ Director, Utilization Management right now, this job will be placed in Mississippi. More complete informations about this job opportunity kindly see the descriptions. Qualis Health, one of the nations leading healthcare consulting organizations, is pursuing an opportunity with the Mississippi Division of Medicaid (DOM) to provide utilizati! on management and quality improvement organization services. The scope of work would include utilization review of acute and ancillary services (hospital, hospice, durable medical equipment, vision, hearing, home health, private duty nursing, outpatient surgeries, outpatient therapies, etc.), behavioral health services (inpatient, community mental health services, residential treatment facility, etc.), and dental services (general dentistry, oral surgery, orthodontic). Also included are health service utilization analysis, focused studies, outcome reports, and recommendations to improve the healthcare delivery system; clinical/medical consultation; peer review; provider education; quality improvement program; and reconsiderations and support for administrative appeals and hearings.In this key role based in or near Jackson, youd serve as our primary point-of-contact with DOM, providers, and other stakeholders. Youd plan, implement, and direct deliverables and activities unde! r this contract (including work flow, budget, and communicatio! ns) and manage the clinical and non-clinical support staff.
Bachelor's degree in nursing, healthcare administration, or a related field. Current, active, unrestricted Mississippi RN licensure. Experience Required At least10 years of work experience that includes 6 years of direct patient care work experience, with at least 3 years in a supervisory or management role. At least 4 years of utilization management work experience. Strong familiarity with Medicaid. Experience with healthcare quality, customer service, and provider relations.
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This job starts available on: Wed, 13 Mar 2013 10:35:23 GMT