Registered Nurse Director of System Utilization
Not Disclosed•Full-TimeOn-site
location_onCanal Street Neutral Ground, Storyville, New Orleans, Orleans Parish, Louisiana, 70112, United States
About the Opportunity
We are partnering with a large, multi-facility health system in the Southeast, comprising over eight hospitals, to find a visionary Director of System Utilization Management. This is a critical leadership role designed to shape the future of resource management and clinical efficiency across the entire network.
The Role
As the Director, you will provide strategic and operational leadership for utilization review and resource management functions. Your mission is to ensure the appropriate use of healthcare services, maintain strict regulatory compliance, and drive optimal reimbursement across all facilities and service lines. You will serve as the bridge between clinical, operational, and revenue cycle leadership, advancing performance improvement initiatives that reduce denials and strengthen financial outcomes.
In this position, you will oversee day-to-day utilization review operations, establishing standardized processes and best practices that promote cost-effective care. You will work collaboratively to optimize length of stay, prevent avoidable days, and foster a culture of high performance and continuous improvement. By analyzing system-level data and leading multidisciplinary committees, you will directly influence clinical and financial success.
Why Join Us
This role offers the chance to lead standardization efforts across a complex, multi-hospital environment. You will have the opportunity to implement system-wide strategies aligned with organizational goals, conduct routine audits to ensure policy adherence, and mentor a team of clinical review staff. Your work will directly impact the quality of care delivered to patients while ensuring the health system's financial sustainability.
Application Instructions
This is an urgent opening. Qualified candidates with a Bachelor's degree in nursing (Master's preferred) and 7–10+ years of progressive leadership experience in Utilization Management or Case Management are encouraged to apply immediately. Experience in multi-hospital leadership and deep knowledge of EPIC workflows are highly valued.
Work location
Work model: On-site
Canal Street Neutral Ground, Storyville, New Orleans, Orleans Parish, Louisiana, 70112, United States
New Orleans, Louisiana
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Skills, education and keywords
Skills: Utilization Management, Case Management, Interqual, MCG, Epic, RN, CMS Regulations.
Education: Bachelor's degree in nursing required; Master's degree preferred.
Frequently asked questions about Registered Nurse Director of System Utilization at Junior State of America (JSA)
What does a Registered Nurse Director of System Utilization at Junior State of America (JSA) do?expand_more
In this Registered Nurse Director of System Utilization at Junior State of America (JSA) role, you will ensure compliance with federal, state, payer regulations, and accreditation requirements; partner with revenue cycle and finance teams to reduce payer denials and optimize reimbursement; lead standardization of utilization management processes across multiple hospital facilities; and develop and implement system-wide utilization management strategies aligned with organizational goals.
What are the requirements for this Registered Nurse Director of System Utilization role?expand_more
To qualify for the Registered Nurse Director of System Utilization at Junior State of America (JSA) position, applicants should have: Bachelor's degree in nursing (master's preferred); 7–10+ years of progressive leadership experience in Utilization Management or Case Management; Active RN license; Certification in Case Management and/or Utilization Management preferred; In-depth working knowledge of EPIC Electronic Health Record System Utilization Management workflows, WQs, and data reporting capabilities; and Strong knowledge of payer requirements, CMS regulations, and accreditation standards.