VUMC Job - 30962684 | CareerArc
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Company: VUMC
Location: Nashville, TN
Career Level: Director
Industries: Healthcare, Pharmaceutical, Biotech


Executive Director of Utilization Management 

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.

Key responsibilities:

    • 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





  • Bachelor's Degree and 8 years of hospital management experience
  • Licensed as an RN or LMSW or above preferred
  • Master's in healthcare or business-related field preferred

Licensure, Certification, and/or Registration (LCR):


RN Licensure Required 





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