Vanderbilt University Medical Center Executive Search Team is conducting a national search for a strong experienced leader for our Executive Director, Utilization Management. This role requires extensive Utilization Management experience, Revenue Cycle and a background that includes strategic process improvements and verifiable results in a large scale medical center.
The Executive Director of Utilization Management holds a leadership role within VUMC Revenue Cycle and is responsible for the overall direction of the Utilization Management program and activities across VUMC. The Director is responsible for strategic initiatives, budgetary and operational management and leadership, program development, and labor management for their functional areas. The Director develops and executes standardization, efficiency and strategies that support the overall performance, quality improvement, and financial health of VUMC. The Director is responsible for the integration and integrity of optimized reimbursement, patient statusing, compliance, and adherence to related guidelines while ensuring high quality outcomes across the institution. This position will oversee 34 FTE's and report to the Associate Vice President of Revenue Cycle Access Services.
Establish strategic direction for utilization review, optimized reimbursement, patient statusing, compliance and adherence to related guidelines
Maintains expertise in reimbursement methods as well as regulatory and accrediting compliance
Participate in quality improvement processes and assures implementation of regulatory standards
Oversight and continued maintenance of dashboard including key performance indicators to measure the quality, timeliness, efficiency of all reviews to provide the optimal statusing based upon patients' needs
Minimize clinical denials by working collaboratively with key partners within the institution
Implements strategies to consolidate and standardize utilization review efforts and models across the health system to positively impact length of stay, observation utilization, denials, physician advisor engagement, peer to peer reviews, and all related metrics
Accurately report the authorization status of patients, denials, and appeals status to the Revenue Cycle Executive Leadership team
Participates in review, selection, upgrades, and training of new technology for use in the Utilization Management area
Identifies new technology that will improve accuracy and efficiency
Work collaboratively with hospital case management leaders and physician advisors to meet strategic and operational excellence goals including high-quality outcomes
Partner with committees across VUMC to develop systems, processes, and programs that build and strengthen the quality of utilization review system wide
Serves as an internal resource and consultant to management, medical staff about cases management, reimbursement, and coordination issues
Model behavior consistent with the mission, vision, and values of the enterprise
Demonstrate a leadership style that is facilitative and collaborative
Serve as a resource and coach to medical center staff, students, and faculty as appropriate
Create an environment that encourages and supports self-development and learning for all staff
Seek out opportunities to improve efficiency and effectiveness for the organization
Establish strategic direction and goals for the departments and functions within Revenue Cycle
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.