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Full-time
bachelor degree, postgraduate degree
Posted 41d ago
~40 hrs/week
Responsibilities
Provide strategic and operational leadership for utilization review and resource management across the health system to ensure cost-effective care. Collaborate with clinical and revenue cycle leadership to reduce denials, optimize length of stay, and ensure regulatory compliance.
Requirements
Requires a Bachelor's degree in nursing and 7-10+ years of progressive leadership experience in Utilization or Case Management. Proficiency in Epic EHR and knowledge of CMS regulations and payer requirements are essential.
Full job description
Your job is more than a job
The Director, System Utilization Management (UM) provides strategic and operational leadership for utilization review, and resource management functions across the health system. This role ensures appropriate use of healthcare services, regulatory compliance, and optimal reimbursement, across all facilities and service lines. The Director oversees day-to-day utilization review operations, establishes standardized processes and best practices, and drives organizational alignment to promote cost-effective care. Working collaboratively with clinical, operational, and revenue cycle leadership, this position advances performance improvement initiatives, reduces denials, and strengthens financial and regulatory outcomes across the system.
GENERAL DUTIES:
1. Strategic Leadership
In conjunction with the Corp VP, Case Management & Utilization, develop and implement a system-wide utilization management strategy aligned with organizational goals.
Lead standardization of UM processes across hospitals.
Collaborate with executive leadership and Case Management to reduce denials, prevent avoidable days, and optimize length of stay (LOS).
Identify trends and implement performance improvement initiatives to enhance clinical and financial outcomes.
Develop a culture of high performance and continuous improvement that values learning and a commitment to quality, including conducting routine, ongoing audits to ensure with UM established policies and procedures.
2. Regulatory & Compliance Oversight
Ensure compliance with federal, state, and payer regulations along with all relevant accreditation and regulatory requirements.
Oversee adherence to InterQual or MCG criteria for medical necessity determinations.
Ensure compliance with third party payor requirements, both governmental and commercial payors.
3. Revenue Cycle Integration
Partner with Revenue Cycle, Finance, and Managed Care teams to reduce payer denials and improve reimbursement.
Monitor denial trends and lead root cause analysis and corrective action plans.
Oversee appeals processes and ensure timely documentation to support medical necessity.
Collaborate with the Physician Advisor Team to both reduce denials and identify areas for clinical documentation improvement; collaborate with the Clinical Documentation Integrity Team (“CDI”) on documentation improvement initiatives.
4. Clinical Operations Oversight
Direct inpatient and outpatient utilization review activities.
Ensure effective communication between physicians, nursing, and payers.
5. Data Analytics & Performance Improvement
Analyze system-level data including but not limited to LOS, readmissions, avoidable days, denial rates, and throughput.
Develop dashboards and KPIs to track performance.
Lead multidisciplinary committees focused on utilization and throughput optimization.
6. Team Leadership & Development
Provide direct oversight to UM manager and clinical review staff.
Establish productivity benchmarks and quality standards.
Mentor leaders and promote professional development.
EDUCATION QUALIFICATIONS:
Bachelor’s degree in nursing, required (master’s preferred).
EXPERIENCE QUALIFICATIONS:
7–10+ years of progressive leadership experience in Utilization Management or Case Management.
Experience in multi-hospital or system-level leadership preferred.
Strong knowledge of payer requirements, CMS regulations, and accreditation standards.
In depth working knowledge and experience of the EPIC Electronic Health Record System Utilization Management workflows, WQs and data reporting capabilities.
LICENSES AND CERTIFICATIONS:
Active RN license (if clinical background).
Certification in Case Management and/or Utilization Management preferred.
WORK SHIFT:
Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary
See opportunities, not problems – it’s all about perspective.
Cheerlead ideas, differences, and each other.
Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
1.To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.
2.To ensure quality care and service, we may use information on your application to verify your previous employment and background.
3.To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.
4.To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
Eight hospitals + dozens of New Orleans area clinics and practices, all focused on keeping you well.
Industry
Hospitals and Health Care
Company size
10,001+ employees
Founded
2009
Headquarters
New Orleans, LA
LinkedIn followers
26,534
We believe a hospital should actually be hospitable.
We’re a New Orleans-based, non-profit health system on a mission: to provide the best possible care for every person and parish in Louisiana and beyond, and to put a little more heart and soul into healthcare along the way. And that means we do things a little differently around here.
Treating people like family is the LCMC Health way, and it always has been. Founded by Louisiana’s first freestanding children’s hospital, we’ve grown into a healthcare system that’s built to serve the unique needs of our communities and families across New Orleans, the Gulf Coast and beyond.
We believe in treating the whole patient, not just the condition. When you visit an LCMC Health facility, you will get the care that is best for you and your family because we believe that shared beliefs and positive outlooks are what drive our exceptional care.
We offer nine hospital locations: Children’s Hospital New Orleans, East Jefferson General Hospital, New Orleans East Hospital, Touro, University Medical Center New Orleans, West Jefferson Medical Center, Lakeview Hospital, and Lakeside Hospital. We also deliver world-class care close to home through a network of urgent care centers across the greater New Orleans area in addition to our physician practices. With over 2,200 board-certified physicians specializing in everything from head to toe, our community can count on us to provide the right care, right where they need it.
We’ve got a rich history, but our sights are set on what comes next. We’re committed to leading the way to a healthier future for the Gulf Coast. That’s why we partner with local universities to bring the latest in care to our patients, and to train the next generation of healthcare professionals that will make a difference right here in our communities.
Offices: 210 State St, New Orleans, LA 70118, US · 200 Henry Clay Ave, New Orleans, Louisiana 70118, US · 5620 Read Blvd, New Orleans, Louisiana 70127, US · 1401 Foucher St, New Orleans, Louisiana 70115, US · 2000 Canal St, New Orleans, Louisiana 70112, US
How many Healthcare jobs are open in New Orleans, LA right now?
There are currently 1,508 open healthcare positions in New Orleans, LA listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in New Orleans, LA?
Companies currently hiring include LCMC Health, Ochsner Health, Tulane University Center for Aging, Compass Group, Tulane SoPA Information Technology Program, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in New Orleans, LA?
Yes — 83 of the 1508 open healthcare positions offer remote or hybrid work (48 remote, 35 hybrid).
How do I apply for Healthcare jobs in New Orleans, LA?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.