Director of Clinical Review

Under the direction of the AVP of Clinical Review and Discharge Planning, the Director of Clinical Review maintains daily operations of the hospital Clinical Review Department.  Excellent communication and interpersonal skills. Team building skills with the ability to function independently and interdependently as a member of the Care Management Leadership Team. Demonstrates the ability to be flexible in work schedules and coverage; this includes the ability to manage some staff remotely. Strong organizational, innovation, and problem-solving skills. Strong decision-making skills.  Ability to establish strong team building with the both internal and external customers.

Directs daily UM operations for the department including staffing, schedules, recruitment, onboarding, and performance management. Responsible for maintaining budget and contributing to future budget development.

Monitors departmental performance indicators, goals and objectives that are consistent with organizational strategic goals, mission, and vision.

Monitors departmental objectives consistent with revenue cycle plan for DNFB, denials, and appeals. Monitors reports and workqueues.  In collaboration with the AVP, Medical Director of UM annually evaluates the UM plan to meet compliance standards.

Maintain the quality of the review process among all personnel including development and implementation of staff audits that give meaningful and measureable data and an understanding of strengths and areas for improvement. Responsible for the development and implementation of process improvements.  Reviews observation/SDS cases daily and initiates communication and referral activity to ensure correct status designation. Active participant in the Utilization Management Committee and subject matter expert who acts as a resource to the team. Recruits, evaluates, mentors, and conduct appropriate disciplinary actions for UM staff. Collaborates with Physician advisors, and  AVP to assure workflows and cases are being addressed according to plan. The above are guidelines for the position but are not necessarily a delineation of all the actions/duties necessary to the job.