Market Director - Utilization Management

Provides operations oversight of the Ascension Utilization Management program across the Ministry Markets assigned and directs tactics to support strategic goals. Ensure integration of utilization management functions with network strategy and claims processing. Oversee work with provider relations on resolving issues. Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives. Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs. Oversee implementation and maintenance of prior authorization codes for all clients. Directs the implementation of tactics to support strategic goals and denial prevention action items. Supports interactions with revenue cycle units and and physician advisors. Accountable for performance of UM clinical operations and supporting achievement of KPI targets.

• Provides operations oversight of the Ascension Utilization Management program across the Ministry Markets assigned and directs tactics to support strategic goals.
• Ensure integration of utilization management functions with network strategy and claims processing.
• Oversee work with provider relations on resolving issues.
• Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
• Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.
• Oversee implementation and maintenance of prior authorization codes for all clients.
• Directs the implementation of tactics to support strategic goals and denial prevention action items.
• Supports interactions with revenue cycle units and and physician advisors.
• Accountable for performance of UM clinical operations and supporting achievement of KPI targets.

• Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required.
• Education: Bachelor's degree in nursing or diploma from an accredited school/college of nursing required.
• Work Experience: 5 years of experience required.
• Additional Preferences: #LI-Remote

• Paid time off (PTO)
• Various health insurance options & wellness plans
• Retirement benefits including employer match plans
• Long-term & short-term disability
• Employee assistance programs (EAP)
• Parental leave & adoption assistance
• Tuition reimbursement

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.