Director of Utilization

Ohio Hospital for Psychiatry; Columbus (OH); On-site; USD 120,000 - 180,000; Full time

Job summary

Ohio Hospital for Psychiatry in Columbus, OH, seeks a Director of Utilization to lead the Utilization Review department. This role directs daily operations, coordinates reviews, and ensures timely, compliant utilization management in inpatient and outpatient psychiatric care.

The position requires a nursing or clinical background with several years of utilization management and supervisory experience, and a commitment to high-quality patient care.

Qualifications

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

Responsibilities

• Direct and manage day-to-day operations of the Utilization Review department.
• Monitor utilization of services and optimize reimbursement while aligning patient benefits.
• Oversee concurrent and retrospective reviews for all patients.
• Liaise between Medicaid reviewers and staff handling required paperwork.
• Collaborate with physicians, therapists and nursing staff to base reviews on patient needs.
• Collaborate with ancillary services to prevent delays in services.

Skills

Clinical experience

Supervisory experience

Utilization management

Education

Bachelor's degree in nursing or clinical field

Master's degree preferred

Job description

Overview

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:

Direct and manage the day-to-day operations of the Utilization Review department.

Responsibilities

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.

Qualifications

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 toprovidingequalemploymentopportunitiestoall applicantsforemploymentregardlessofanindividual’scharacteristicsprotected byapplicable state,federalandlocallaws.

AHCORP