Join a world-class academic healthcare system, UChicago Medicine, as the Assistant Director of Utilization Review responsible for providing management and supervision to Utilization Management Nurses, Utilization Review Assistants and Registry UM staff and to assist the ED in the day to day functioning of the department through scheduling, quality assurance, problem solving, recruitment, evaluation of staff competency and performance and maintenance of department budget. This is a hybrid-remote position based in Chicago, IL. While there is flexibility to work from home, the Assistant Director will be required to work onsite a few times per month.

As the Assistant Director of Utilization Review, you will be responsible for creating and revising standard work for the UR team and implementing new operational workflows. The Assistant Director will establish relationships with other health care professionals and community groups and coordinate the services of the department relating to other relevant agencies. The Assistant Director of Utilization Review will also promote, have knowledge of, and utilize appropriate patient care protocol relating to the physical, psychosocial and developmental needs of neonatal, pediatric, adult and geriatric patients.

Who you are:

An organized and strategic leader with:

• Bachelor of Science in Nursing preferred, Masters in Nursing or related field required
• Active Registered Nurse license
• Certification in Case Management preferred
• Strong clinical background, with minimally 5 years of experience in utilization review
• Demonstrated knowledge and experience in project management, effective managerial skills and principles surrounding quality improvement and utilization management
• Strong computer skills (MS Office, Word, Excel) and experience with data management necessary
• Effective communication style and a hands-on, teambuilder mindset
• Current working knowledge of case management, discharge planning, utilization review, bed access and staffing resource office

What you’ll do as the Assistant Director of Utilization Review at UChicago Medicine:

• Manage the clinical practice of Utilization Management practice in the pediatric and adult hospitals, ensuring quality of service on a 24-hour basis.
• Provide clinical supervision and oversight of staff Utilization Management nurses, Utilization Review Assistants and Registry Utilization Management nurses and takes primary responsibility for the training and orientation of new staff to the Department of Care Coordination.
• Ensure that supportive care coordination services are delivered to patients in a timely manner by developing well-trained, dedicated staff who are available both during normal business hours and after hours (by phone or on site).
• Establish and implement an annual Quality Improvement Program and Utilization Management Plan in Case Management, in conjunction with the Director of Case Management.
• Co-Chair the Utilization Management Committee and assist in preparation of materials to support the Committee’s work.
• Maintain awareness and knowledge of current clinical issues, regulatory processes, or advances relevant to departmental decision-making and functioning. Participates in regular continuing education.
• Participates in regional and national professional meetings, representing the department. Understands changes in health care delivery and payor systems within health care systems.
• Assist in the development/management of a denials/appeals system including data monitoring and committee review process.
• Be available to support case management staff and all entry points in crisis situations, and be an active, experienced problem-solver.
• Complete medical chart documentation as required.
• In conjunction with Executive Director, manage the department dashboard and avoidable day collections.
• Support the Executive Director in managing the department within the frame work of the annual budget.
• Ensure processes are developed and implemented to support compliance with conditions of participation for Utilization Management.

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