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System Utilization Management Director

Company: BJC HealthCare
Location: Saint Louis
Posted on: October 8, 2021

Job Description:

Information About this Position


Company and Job Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $5.5 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.


BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.


BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.



Role Purpose

System Utilization Management Director leads and directs the utilization review staff and function for BJC HealthCare including organizing, directing, and controlling all internal operations of assigned clinical departments in Utilization Management/Review. Works in collaboration with medical staff, inpatient case managers and social work, patient access and pre arrival, and revenue cycle team to manage UM process for patients admitted to BJC hospitals. System Utilization Management Director implements standard processes e.g. timely payer reviews and notifications to ensure that the patient is getting the right care in a timely and cost-effective way.


  • Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
  • Develops and adheres to departmental staffing, revenue and/or expense budgets. Responds to changes in the business which may affect the ability to achieve the budget goals.
  • Oversees creation and implementation of UM policies and procedures that incorporate best practices, ensure effective utilization review processes, and meet payer requirements.
  • Acts as a catalyst between the UM and related departments including patient access, case management, physician advisors, pre-arrival, HIM, and the denials and appeals team to ensure continuity and quality of service and care.
  • Develops and analyzes reports to identify significant utilization trends, patterns, and impacts on resource utilization that supports the work of HSO UM committees.
  • Performs Other Responsibilities as Assigned

Minimum Requirements

Preferred Qualifications

Preferred Requirements

Benefits Statement

Note: not all benefits apply to all openings

-  Comprehensive medical, dental, life insurance, and disability plan options
-  Pension Plan*/403(b) Plan
-  401(k) plan
-  Tuition Assistance
-  Health Care and Dependent Care Reimbursement Accounts
-  On-Site Fitness Center (depending on location)
-  Paid Time Off Program for vacation, holiday and sick time

*Pension does not apply to Memorial Hospital, Memorial Hospital East, Alton Memorial or Parkland Health Center

Legal Statement

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.


Equal Opportunity Employer




Keywords: BJC HealthCare, St. Louis , System Utilization Management Director, Other , Saint Louis, Missouri

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