Nationwide Children’s Hospital has retained LeaderStat Premier to assist them in identifying a Utilization Management Director.
Would you like to work for an organization where everything matters?
Nationwide Children’s Hospital is a destination academic pediatric medical center designed to manage the most complex of diseases. Nationwide Children’s Hospital has again ranked in the U.S.News & World Report’s “America’s Best Children’s Hospitals.” They also achieved ANCC Magnet Recognition Program® status, designating them as a hospital that provides world-class patient care and innovation in nursing practice.
Seeing more than 1 million patients annually, they are one of the country’s largest not-for-profit freestanding pediatric health care networks. With nearly 12,000 hospital staff and 1,000 medical staff they have been providing the best possible care since 1892.
The Utilization Management Director is responsible for leading a variety of activities that ensure the most efficient use of healthcare services to patients of Nationwide Children's Hospital and Partners for Kids, one of the nation’s oldest and largest pediatric accountable care organizations.
The Director of UM reports to the Vice President of Care Coordination and Utilization Management and is responsible for discharge planning nurses, utilization review nurses and works closely with service line, data and finance teams.
Identifies opportunities to improve inpatient discharge planning, utilization management and communication amongst payers, providers, and organizations.
Sets and monitors performance targets.
Develops recommendations to increase efficiency of delivery of quality health care services to department senior management.
Participates in, oversees, and assumes responsibility for the development of goals within assigned areas of responsibilities which are congruent with and support Nationwide Children’s and Partner for Kids strategic goals.
Works collaboratively with Managed Care and Patient Financial Services to communicate and understand payer requirements.
Provides direction to the Program Manager of Inpatient Care Coordination and Program Manager of Utilization Management for timely completion of concurrent inpatient utilization review and precertification.
Communicates with medical staff leadership to achieve reduction in denials.
Serves as an internal expert on utilization management processes, NCQA standards and regulatory requirements; disseminates departmental expertise through training and other educational resources for physicians and staff.
Ensures compliance with federal and state regulations, JCAHO and other regulatory agencies, and internal standards and requirements.
Are you a passionate expert in utilization management, and an accomplished leader? Do you enjoy defining opportunities to produce meaningful change, improve processes, and working with engaged teams throughout an organization? If so, then we would like to speak with you about this unique leadership role within Nationwide Children’s Hospital.
We welcome your confidential expressions of personal interest and nominations of qualified colleagues. Inquiries and questions concerning this search may be directed to Jim Passias at firstname.lastname@example.org or 614-505-7356
Internal Number: 9109
About Nationwide Children's Hospital
LeaderStat specializes in interim management, executive recruiting and consulting for post-acute and senior care organizations. We offer an extensive network of experienced professionals who are available for interim and permanent leadership positions nationwide.