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Regional Director, Utilization Review/Case Management in Kansas City, MO at Prime Healthcare Services Inc

Date Posted: 6/7/2019

Job Snapshot

Job Description


The Regional Director of Utilization Review/Case Management will provide leadership and oversight to the utilization review process. The Regional Director of Utilization Review/Case Management will oversee the respective processes and functions performed by the managers, supervisors and clerical staff in the UM and Case Management departments. The Regional Director will manage coordination between the corporate Denials Management, Case management, Administration, HIM, Coding, ROI, Business Office, Financial Services and CMO for utilization Review. The Regional Director is responsible for education of physicians, nurses and related staff on documentation requirements for the Governmental claims and compliance. Facilitate appropriate resource management to ensure quality and cost effective outcomes. Other Duties as assigned.


  1. Bachelor’s degree in Medicine or Nursing or related field.
  2. Two (2) years of supervisory experience in Utilization Management.
  3. Proficiency in utilization review (InterQual-IQ or Milliman Care Guidelines-MCG)

Preferred qualifications:

  1. Minimum of two years’ experience in Utilization review and Denials management.
  2. Extensive knowledge of clinical measurement tools, and clinical outcomes; ability to establish cooperative working relationship with diverse groups and individuals, the medical staff, and other healthcare disciplines; program and database development.
  3. ECFMG certification or Strong broad-based clinical knowledge and understanding of Pharmaceuticals, Pathology physiology of disease processes
  4. Excellent written and verbal communication skills. Excellent critical thinking skills.
  5. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.


We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: