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Utilization Review Director Jobs in Puerto Rico (NOW HIRING)

Pacs

$70K - $85K/yr

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Perform clinical assessments, care planning, and direct coordination of medical services when ...

UHS

PR · On-site

Establish direct communication with leaders and representatives of the Behavioral Health Contact ... Provide backup to Utilization Review Department out of business hours including document in the ...

Ultimate Solutions

... utilization of best process. * At higher levels, may lead and direct the work of others. * Build ... Generates, executes, reviews, and complete qualification and validation protocols, summary reports ...

chicosfas

Sales Associate - Soma

San Juan, PR

$13.75 - $18.75/hr

... as directed by Management. * Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

chicosfas

Sales Associate - Soma

San Juan, PR · On-site

$13.75 - $18.75/hr

... as directed by Management. * Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

Ferrovial

Segment/Discipline Manager

San Juan, PR

This role provides direct leadership over construction activities within the assigned scope ... Support the review and implementation of construction means and methods, temporary works, and ...

Chico's FAS

Sales Associate - Soma

San Juan, PR

$9 - $12.25/hr

... as directed by Management. • Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

Chico's FAS, Inc.

Sales Associate - Chico's

Ponce, PR · On-site

$13.75 - $18.50/hr

... as directed by Management. * Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

Chico's FAS, Inc.

Sales Associate - Soma

San Juan, PR · On-site

$13.75 - $18.75/hr

... as directed by Management. * Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

Chico's FAS

Sales Associate - Chico's

Ponce, PR

$13.75 - $18.50/hr

... as directed by Management. • Participates in visual directives including monthly store sets and ... When we do have an open position, we will review your application to determine if your ...

Veterans Health Administration

$236K - $400K/yr

... direct patient care, and is actively involved in the decisions that support the management of ... Ensure that appropriate systems are in place to review, analyze, and evaluate patient care ...

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All JobsUtilization Review Director JobsUtilization Review Director Jobs in Puerto Rico

Utilization Review Director information

What is the difference between Utilization Review Director vs Utilization Review Nurse?

AspectUtilization Review DirectorUtilization Review Nurse
CredentialsRN license, management experience, certifications (e.g., CCM)RN license, certification in case management or utilization review (e.g., CUC)
Work EnvironmentAdministrative, leadership roles overseeing teamsClinical, review of patient cases, direct patient care
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentLeadership, management, strategic planning in utilization reviewClinical review, case assessment, patient care coordination

The Utilization Review Director typically oversees review teams and manages utilization strategies, requiring leadership skills and management experience. In contrast, the Utilization Review Nurse focuses on clinical case assessments and patient care reviews. Both roles require RN licensure and relevant certifications but differ mainly in scope and responsibilities.

What does a Utilization Review Director do?

A Utilization Review Director oversees the evaluation of medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead teams that review patient care requests, manage compliance with regulations, and implement strategies to ensure cost-effective care without compromising quality. Their responsibilities often include policy development, data analysis, and collaboration with healthcare providers to optimize resource use and improve patient outcomes.

What are some common challenges faced by a Utilization Review Director, and how can they be addressed?

A Utilization Review Director often navigates challenges such as balancing regulatory compliance with organizational goals, managing interdisciplinary teams, and keeping up with evolving healthcare policies. Staying proactive with ongoing education, fostering open communication among staff, and implementing efficient review processes can help address these issues. Additionally, leveraging data analytics and technology streamlines case reviews and ensures evidence-based decision-making, ultimately improving both patient outcomes and operational efficiency.

What are the key skills and qualifications needed to thrive as a Utilization Review Director, and why are they important?

To thrive as a Utilization Review Director, you need a deep understanding of clinical guidelines, healthcare regulations, and case management principles, typically supported by a nursing or related healthcare degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHR), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) is common in the field. Strong leadership, communication, analytical thinking, and decision-making skills help you effectively manage teams and ensure compliance. These competencies ensure efficient resource use, regulatory adherence, and high-quality patient outcomes within healthcare organizations.
What are the most commonly searched types of Utilization Review jobs in Puerto Rico? The most popular types of Utilization Review jobs in Puerto Rico are:
Utilization Review Director jobs near you

Case Manager LVN

Pacs

$70K - $85K/yr

Full-time

Posted 18 days ago

Job description

General Purpose

  • Utilize clinical expertise and critical thinking skills to work collaboratively with residents, resident family/significant other, healthcare providers, insurers, community resources and other involved parties to develop and implement a plan of care that provides extraordinary care for the patient while being sensitive to costs and resources.

Pay Range

$70,200-$85,000 annually

Essential Responsibilities

  • Communicate regularly with residents and their family about Plans of Care, PT, OT and other treatment protocols.

  • Attends and participates in morning meetings/stand up to facilitate communications with the team.

  • Answer residents' questions about their care, treatment plans, illness progression and all other issues so they feel safe and secure in our care.

  • Monitor and adjust residents' statuses based on changing needs and conditions.

  • Organize and prioritize daily work by assessing new, current and discharging residents' needs in the area(s) of responsibility.

  • Complete documentation as required.

  • Performs utilization review activities to provide resident appropriate, timely and cost-effective care.

  • Coordinate care with resident, care providers, facilities financial services, and third-party payers.

  • Oversee all admissions and discharge activities.

  • Coordinate referrals both to and from our facility.

  • Ability to relate positively, effectively, and appropriately with residents, families, staff and professionals

  • colleagues.

  • Accurate charting and ability to complete necessary paperwork in a timely manner.

  • Ability to work independently and exercise sound judgement in interactions with physicians, providers, payers and residents and their families.

  • Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including residents/families/caretakers, physicians, nurses and other ancillary partners.

  • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

  • Intermediate computer skills.

  • Competence in maintaining professional, respectful, honest interactions with residents/families and staff and partners.

  • Perform clinical assessments, care planning, and direct coordination of medical services when required by the role

Supervisory Requirements

This position has no supervisory responsibilities.

Qualification

Education and/or Experience

  • Bachelor's Degree in Nursing or Social Work. Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable.

  • Two (2) years of clinical nursing experience preferred.

  • Knowledge of Medicare, Medi-cal and Medicaid programs and benefits.

  • PCC Knowledge preferred.

  • Certificate as a certified Case Manager (CCM) a plus.

  • Must maintain all required continuing education/licensing.

  • Must remain in good standing with the Department of Public Health, License and Certification Division at all times.

Physical Demands

  • Primarily sedentary with frequent sitting, computer use, and documentation.

  • Regular walking throughout the facility to meet with residents, families, and staff.

  • Occasional standing during meetings and care conferences.

  • Ability to lift and carry up to 20 pounds (files, binders, supplies).

  • Clear verbal communication and vision required for chart review and resident interaction.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually low to moderate.

We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.

About PACS

Sourced by ZipRecruiter

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Farmington, UT, US

Year founded

2013

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