Director of Utilization

Ohio Hospital for Psychiatry; Columbus (OH); On-site; USD 110,000 - 150,000; Full time

Job summary

Ohio Hospital for Psychiatry, LLC is seeking a Director of Utilization to join our leadership team and support patients receiving specialized psychiatric care.

The role oversees utilization review, collaborates with physicians and staff, and ensures compliant processes while optimizing payer benefits and access to services.

Qualifications

• Bachelor's degree in nursing or other clinical field required.
• Master's degree in clinical field preferred.
• Six or more years of clinical experience with the facility population preferred.
• Four or more years of utilization management experience required.
• Three or more years of supervisory experience required.

Responsibilities

• Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
• Conduct concurrent and retrospective reviews for all patients.
• Serve as liaison between Medicaid reviewers and staff to facilitate the Utilization Review process.
• Collaborate with physicians, therapist and nursing staff to provide optimal review based on patient needs.
• Collaborate with ancillary services to prevent delays in services.
• Evaluate the UM program for compliance with regulations, policies and procedures.
• Provide staff management including hiring, development, training, performance management and communication.

Skills

Utilization management

Supervisory experience

Clinical collaboration

Education

Bachelor's degree in nursing or other clinical field

Master's degree in clinical field

Job description

We are currently seeking a Director of Utilization to join our leadership team and support our patients receiving specialized psychiatric care.

Ohio Hospital for Psychiatry is a leading medical acute inpatient & outpatient treatment center in Columbus, OH, treating suicide, addiction, memory disorders & mental health issues.

This 130-bed acute care hospital offers a wide range of services, including Adult and Senior Inpatient Programs, Dual Diagnosis Programs, and Intensive Outpatient Programs (IOP) to address community needs.

Purpose Statement

Essential Functions

• Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
• Conducts and oversees concurrent and retrospective reviews for all patients.
• Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
• Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
• Collaborates with ancillary services in order to prevent delays in services.
• Evaluates the UM program for compliance with regulations, policies and procedures.
• May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

Other Functions

• Perform other functions and tasks as assigned.

Education/Experience/Skill Requirements

• Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
• Six or more year's clinical experience with the population of the facility preferred.
• Four or more years’ experience in utilization management required.
• Three or more years of supervisoryexperience required.

Licenses/Designations/Certifications

• If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

AHCORP