Director of Clinical Review Management
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Job Location:
Monthly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Overview
At St. Lukes we pride ourselves on fostering a workplace culture that values diversity promotes collaboration and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth competitive benefits and a supportive community of colleagues St. Lukes is truly a great place to work.
The Director of Clinical Review Management provides strategic and operational leadership across multiple settings and operating units to lead the organizations utilization management function in support of SLHS mission vision and strategic objectives.
What You Can Expect:
- Provides overall strategic direction and oversight of the day to-day operations of utilization programs to meet hospital system and network utilization goals while maintaining high quality of care and outstanding customer satisfaction
- Responsible for utilization management and criteria-based reviews of care clinical appeals regarding medical necessity and the interaction with claims payment policies and processes. Monitors the organizational utilization of services and optimize reimbursement for the organization while maximizing use of the patients provider benefits for their needs
- Collaborates with providers care management case management revenue cycle denials and appeals and other groups to manage the total cost of care through the development and execution of clinical and operational programs to manage costs and ensure quality care delivery.
- Experience managing large teams experience in change management process improvement with compliance and CMS at the forefront
- Knowledge of denial management and MCG/IQ experience
Qualifications:
- Education: Bachelors Degree in Nursing or Masters Degree in a healthcare related field.
- Experience: 8 years experience
RN strongly preferred
Please contact Julie @ for questions
Whats in it for you
At St. Lukes caring for people in the communities we serve is our mission and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and addition to a competitive salary and retirement plans we ensure our team feels supported in their benefits beyond the typical medical dental and vision offerings. We care about you and have fantastic financial and physical wellness options such as: on-site massages on-site counseling via our Employee Assistance Program access to the Personify Health Wellness tool as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Lukes is an equal opportunity employer and does not discriminate against any person on the basis of race religion color gender gender identity sexual orientation age national origin disability veteran status or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
Required Experience:
Director
Key Skills
- Crisis Management
- Marketing
- Public Relations
- Fundraising
- Media Relations
- Constant Contact
- Strategic Planning
- Social Media Management
- Team Management
- Public Speaking
- Wordpress
- Writing Skills
