Talent.com
RN System Director Utilization Management - Relocation Offered!
RN System Director Utilization Management - Relocation Offered!MedStar Health • Clinton, MD, United States
No longer accepting applications
RN System Director Utilization Management - Relocation Offered!

RN System Director Utilization Management - Relocation Offered!

MedStar Health • Clinton, MD, United States
18 days ago
Job type
  • Full-time
Job description

General Summary of Position

MedStar Health is looking for a System Director of Utilization

With 10 nationally respected hospitals and over 500 specialty, urgent care, and primary care locations. MedStar Health is the leading healthcare provider in Maryland, DC, and Virginia.

The System Director of utilization is responsible for overseeing utilization review operations across a defined group of hospitals within designated region of Maryland or the District of Columbia. Possesses deep knowledge and expertise specific to regulatory requirements of the region. Responsible for operationalizing strategic vision in partnership with system ACM leaders. Ensures consistent application of evidence-based review practices with oversight and performance management of UR RN teams. Drives performance aligned with regulatory and payor expectations, ensuring the delivery of high-quality care, operational efficiencies, reduction in avoidable utilization, and collaboration with clinical and operational stakeholders.

Requirements :

  • MSN Required
  • Active DC or MD RN license Required
  • 5-7 years' experience in Utilization Management with 3-5 years' experience in Utilization Management Leadership Required
  • 3-5 years' experience in acute care bedside nursing Required

Primary Duties and Responsibilities

  • Directs and develops Utilization Review RN teams and their managers across service lines and region, ensuring operational efficiency and effective cross coverage.
  • Drives departmental strategy by analyzing key metrics and productivity data, identifying trends requiring rapid attention, and collaborating with stakeholders to implement real-time" solutions
  • Oversight and awareness of daily utilization review functions, including admission and continued stay reviews, appropriate level-of-care determinations, and pre-bill denial interventions
  • Serves as regional regulatory expert, monitoring policy changes, identifying trends requiring escalation, and maintaining compliance with state specific regulations including reimbursement structures, Medicaid requirements, and review protocols.
  • Manages UR RN float pool for region and ensures operational efficiencies and continuity across hospitals, including during volume surges, staff leave, or transitions.
  • Participates in the development of systemwide goals, policy updates, and technology implementations impacting utilization management. Leads initiatives to support department strategy, i.e., length of stay, observation conversion, timely reviews, and complex clinical cases by monitoring and reporting regional utilization metrics.
  • Serves as the primary contact for hospital executive and clinical leadership in the designated region, aligning utilization management strategies with local needs under the direction of senior leadership while promoting efficiency and regulatory compliance
  • Performance management of staff including float pool, ensuring licensure, competencies, and annual performance reviews.
  • Leads UM Committee, in partnership with physician advisor, for each hospital within region. Ensures connectivity and cadence of communication with each ACM Director, Physician Advisor, and CMO at each site. Responsible for escalations and connectivity to long length of stay and complex discharge team, as well as revenue cycle management.
  • Facilitates cross-functional collaboration with discharge planning / care coordination, physician advisors, and medical staff to optimize resource use.
  • Provides training, mentorship, and professional development opportunities for UR teams, supporting retention, engagement, and high performance. Leads onboarding and orientation, in partnership with other key leaders, for all new hire UR RNs.
  • Leads ongoing education and competency of entire UR RN team ensuring quality reviews and criteria usage. This includes interrater reliability, Sitel modules, Compass education modules, and updates to MCG and InterQual.
  • Ensures compliance with CMS guidelines, commercial payor requirements, and accreditation standards (i.e. Joint Commission)
  • Provides clinical assessment, evaluation, and disposition of persons presenting with behavioral health concerns or illness.
  • Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
  • Participates in multi-disciplinary quality and service improvement teams.
  • Minimal Qualifications

    Education

  • Bachelor's degree Science in Nursing (BSN) required and
  • Master's degree in Nursing (MSN), Healthcare Administration, Business or related field required
  • One year of relevant education may be substituted for one year of required work experience.
  • Experience

  • 5-7 years Utilization Management experience required
  • 3-4 years Nursing experience in acute care setting required and
  • 3-4 years progressive leadership / staff management experience, ideally in a multi-facility or system role required
  • One year of relevant professional-level work experience may be substituted for one year of required education.
  • Licenses and Certifications

  • RN - Registered Nurse - State Licensure and / or Compact State Licensure in the State of Maryland or District of Columbia Upon Hire required and
  • Certification - Nursing Administration or Professional (Specialty) MCG or Change Health (Interqual) Certification Upon Hire preferred and
  • CCM - Certified Case Manager Upon Hire preferred and
  • Accredited Case Manager (ACM) Upon Hire preferred
  • Knowledge, Skills, and Abilities

  • Excellent leadership, communication, and team development skills
  • Strong analytical and operational decision-making capabilities
  • Strong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agencies.
  • Ability to build comprehensive reports and effectively convey information to others
  • Working knowledge of various computer software applications preferred. individual with the ability to multitask.
  • This position has a hiring range of $142,064 - $287,996

    Required

    Preferred

    Job Industries

  • Other
  • Create a job alert for this search

    Rn Utilization Management • Clinton, MD, United States

    Related jobs
    Senior Director, Data Center Engineering (Remote - USA)

    Senior Director, Data Center Engineering (Remote - USA)

    Cologix • Ashburn, VA, US
    Remote
    Full-time
    Based in Denver, Colorado, Cologix is North America's leading network-neutral interconnection and hyperscale edge data center company. Our platform gives customers access to 45+ digital edge and...Show more
    Last updated: 16 days ago • Promoted
    Senior Manager, IT R&D Systems

    Senior Manager, IT R&D Systems

    VirtualVocations • Alexandria, Virginia, United States
    Full-time
    A company is looking for a Senior Manager, IT R&D Systems.Key Responsibilities Lead a team of IT professionals to support R&D systems and define the strategic roadmap Oversee daily operations an...Show more
    Last updated: 4 days ago • Promoted
    RN Licensed Utilization Management Director

    RN Licensed Utilization Management Director

    VirtualVocations • Alexandria, Virginia, United States
    Full-time
    A company is looking for a Director, Utilization Management Support Operations.Key Responsibilities Directs the utilization management team to ensure compliance with policies and procedures for o...Show more
    Last updated: 30+ days ago • Promoted
    RN - Telemetry in California, MD - $2,440 / week

    RN - Telemetry in California, MD - $2,440 / week

    Vetted Health • California, MD, US
    Full-time
    Vetted is seeking a RN - Telemetry for a travel job in Leonardtown, Maryland.The assignment starts on ASAP and is 13 weeks long with 10 hour shifts 5 days a week. You must live 60 miles away from th...Show more
    Last updated: 30+ days ago • Promoted
    Director of Enterprise Applications

    Director of Enterprise Applications

    VirtualVocations • Washington, District of Columbia, United States
    Full-time
    A company is looking for a Director of Enterprise Applications.Key Responsibilities Develop and implement IT strategies for enterprise applications, ensuring alignment with business goals Mentor...Show more
    Last updated: 30+ days ago • Promoted
    Tennessee RN Utilization Review

    Tennessee RN Utilization Review

    VirtualVocations • Rockville, Maryland, United States
    Full-time
    A company is looking for an RN Utilization Review.Key Responsibilities Perform clinical assessments and evaluate injured employees' treatment utilization and compliance Collaborate with healthca...Show more
    Last updated: 4 days ago • Promoted
    RN Director of Nursing Capacity and Resource Management

    RN Director of Nursing Capacity and Resource Management

    Medstar Good Samaritan Hospital • Clinton, MD, US
    Full-time
    RN Director Of Nursing For Float Pool.MedStar Southern Maryland Hospital Center is looking for an RN Director of Nursing for our Float Pool. This is a day shift working 5 days per week.Our hospital ...Show more
    Last updated: 30+ days ago • Promoted
    IT Applications Director - Enterprise Systems

    IT Applications Director - Enterprise Systems

    Clark Construction Group • Falls Church, VA, US
    Full-time
    IT Applications Director - Enterprise Systems.The IT Applications Director - Enterprise Systems will lead the strategic and operational management of Clark Construction Group's critical suite of en...Show more
    Last updated: 30+ days ago • Promoted
    RN - Telemetry in Callaway, MD - $2,440 / week

    RN - Telemetry in Callaway, MD - $2,440 / week

    Vetted Health • Callaway, MD, US
    Full-time
    Vetted is seeking a RN - Telemetry for a travel job in Leonardtown, Maryland.The assignment starts on ASAP and is 13 weeks long with 10 hour shifts 5 days a week. You must live 60 miles away from th...Show more
    Last updated: 30+ days ago • Promoted
    Senior Engineering Manager - Open Source ServerUnited States - Remote Opportunity

    Senior Engineering Manager - Open Source ServerUnited States - Remote Opportunity

    Temporal Technologies • Washington, DC, US
    Remote
    Full-time +1
    Senior Engineering Manager - Open Source Server.Temporal is hiring a Senior Engineering Manager to lead our Developer Experience team within the Temporal Core organization (Open Source Server, OSS)...Show more
    Last updated: 30+ days ago • Promoted
    Director of Advancement Systems and Operations

    Director of Advancement Systems and Operations

    BridgePoint Associates • Washington, DC, US
    Full-time
    Director of Advancement Systems and Operations.Salary : $115,000 to $120,000 per year, based on experience.Excellent benefits including : 35 days of PTO per year, 403(b) retirement plan with a 7% emp...Show more
    Last updated: 30+ days ago • Promoted
    Director, Data Center Cross Functional Engineering - AMER-East

    Director, Data Center Cross Functional Engineering - AMER-East

    Clearance Jobs • Ashburn, VA, US
    Full-time
    Director Of Data Center Cross-Functional Engineering.Equinix is the world's digital infrastructure company, operating over 260 data centers across the globe. Digital leaders harness Equinix's truste...Show more
    Last updated: 30+ days ago • Promoted
    Systems Engineering Manager

    Systems Engineering Manager

    Umbra • Arlington, VA, US
    Full-time +1
    Quick Apply
    Umbra is an American space technology company delivering advanced systems, from sensors to spacecraft, that empower customers worldwide with unmatched access to critical information from space.Our ...Show more
    Last updated: 24 days ago
    Restaurant Delivery - Sign Up and Start Earning

    Restaurant Delivery - Sign Up and Start Earning

    DoorDash • Charlotte Hall, MD, United States
    Full-time +1
    DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you’ll stay busy with a variety o...Show more
    Last updated: 1 day ago • Promoted
    Director, Systems Engineering

    Director, Systems Engineering

    IMPaCT Care • Washington, DC, US
    Full-time
    Amid clinical workforce shortages, rising healthcare costs and concerns about inequity, IMPaCT unlocks the power of the grassroots community health workforce. Here at IMPaCT Care, we get out of bed ...Show more
    Last updated: 11 hours ago • Promoted • New!
    Ohio Licensed Utilization Management RN

    Ohio Licensed Utilization Management RN

    VirtualVocations • Alexandria, Virginia, United States
    Full-time
    A company is looking for a Utilization Management RN Reviewer.Key Responsibilities Conduct admission, concurrent, and retrospective reviews of patient charts and clinical systems Collaborate wit...Show more
    Last updated: 4 days ago • Promoted
    RN Director of Nursing DON

    RN Director of Nursing DON

    CommuniCare Corporate • Alexandria, VA, US
    Full-time
    Mt Vernon Healthcare Center, a member of the CommuniCare Family of Companies, is currently recruiting an experienced and compassionate RN to lead our nursing team as Director of Nursing!.CommuniCar...Show more
    Last updated: 27 days ago • Promoted
    RN

    RN

    Target • Waldorf, MD, US
    Part-time
    Pay is based on several factors which vary based on position.These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Tar...Show more
    Last updated: 8 hours ago • Promoted • New!