Director Utilization Management
At Harris Health System, we champion better health for our patients, their families and our community, by connecting them to an integrated healthcare system that provides high-quality healthcare. Harris Health focuses on the delivery of primary care, wellness and prevention services to the residents of Harris County, Texas, through its extensive network of inpatient and outpatient facilities. Harris Health is a proud recipient of the prestigious National Committee for Quality Assurance designation for its patient-centered medical homes. Harris Health's medical faculty and residents are provided by its nationally recognized medical school partners: Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); and The University of Texas MD Anderson Cancer Center.
The Director of Utilization Management reports to the Senior Vice President of Medical Affairs and serves as the change agent for the planning, oversight, and implementation of system-wide and pavilion-specific strategic plans and programs related to utilization management and utilization review. In collaboration with service initiatives, the Director of Utilization Management will ensure standardization and direction to utilization using creative approaches to engage stakeholders in collaboration with system and pavilion operations across the organization. Activities include leveraging the development and implementation of programs and processes designed to promote patient-centered excellence, sustaining DNVGL-NIAHO accreditation requirements, and collaboration with other division and department leaders. The Director will ensure clarity and conformity regarding utilization expectations, responsibility, accountability in alignment with the system¿s strategic plan, and medical necessity regulatory requirements, documentation standards, policies and other programmatic activities to enhance a value-based approach to professional practice, and thoughtful optimization of investments in support of utilization within the healthcare system.
Other duties include the coordination of the Utilization Committees with administrative oversight of a team to accomplish a value-based approach to ensure performance, access, experience and cost effectiveness. Exercises a competency-based approach in the evaluation of policies, as a content expert on topics related to the Utilization Review/Utilization Management (UR/UM) that focuses on delivery system evidence-based outcomes, research-valued, and targeted to achieve system and departmental goals.
1.Education/Specialized Training/Licensure:Graduation from an accredited school of nursing with a bachelor¿s degree in Nursing and a master¿s degree in healthcare-related field required
Relevant specialty certification (CPHQ preferred) to be completed within two (2) years of employment
Current license or valid permit to practice professional nursing in Texas
2.Work Experience (Years and Area):Ten years of System Level Healthcare-Based Strategic Planning Experience and/or Operational Oversight
3.Management Experience (Years and Area):Five years supervisory experience
4.Equipment Operated:Regular office equipment
SPECIAL REQUIREMENTS: (Check Applicable Areas)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing (Correspondence / Reports )
2. Other Skills:
Analytical CRT Design Medical Terms Research P.C. MS Word MS Excel
3. Advanced Education:
Advance TrainingSpecialty:Relevant certification (CPHQ preferred) to be completed within 2 years of employment
Bachelor¿s Degree Major:Nursing
Master¿s DegreeMajor:Healthcare-related field
4. Work Schedule: Holidays Flexible
Benefits and EEOC
Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.