Director of Utilization Management

Director Of Utilization Management

At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system. We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.

Summary of the Job : The Director of Utilization Management provides strategic leadership, oversight and operational management for all utilization review and medical necessity processes within the health system. This role ensures patient care is delivered at the appropriate level of care, ensures regulatory compliance, optimizes patient flow, supports high-quality clinical outcomes, and manages resource utilization across the acute care continuum. The Director collaborates with medical staff, nursing, revenue cycle and external partners to optimize patient throughput, reduce denials, and improve overall efficiency in care delivery.

Minimum Qualifications : Bachelor's degree in Nursing or related healthcare field. Current RN license in the state of practice. Minimum 710 years of experience in acute care hospital setting. At least 35 years in a utilization management or case management leadership role. Strong understanding of managed care principles, hospital reimbursement, and regulatory compliance.

Preferred Qualifications : Master's degree in Nursing, Health Administration, or related field. Certification in Case Management (CCM or ACM).

Physical Demands : Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required. Must be able to work with a moderate level of noise.

Physical Effort Required : Constant (67%-100%) talking, hearing, seeing. Frequently (34%-66%) NONE. Occasionally (1%-33%) lifting, carrying, pushing / pulling, climbing (stairs, ladders, etc.), balancing, stooping, crouching, crawling, reaching, handling / feeling.

Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision, and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.

St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.