Director of Utilization

Acadia Healthcare; Kennett Square (Chester County); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

Harboroaks in Kennett Square, PA is seeking a leader to direct and manage the day-to-day operations of the Utilization Review department, ensuring efficient concurrent and retrospective reviews and optimal reimbursement for services.

You will liaise with Medicaid reviewers, collaborate with physicians, therapists and nursing staff, oversee staff development and training, and drive compliance with regulations while maintaining high-quality patient care.

Qualifications

• Bachelor's degree in nursing or a clinical field required.
• Master's degree in a clinical field preferred.
• Six+ years of clinical experience with the population served.
• Four+ years of utilization management experience and three+ years of supervisory experience.

Responsabilités

• Direct and manage day-to-day operations of the Utilization Review department.
• Monitor service utilization and optimize reimbursement while maximizing patient provider benefits.
• Conduct concurrent and retrospective reviews for all patients.
• Liaise between Medicaid reviewers and staff to facilitate the UR process.
• Collaborate with physicians, therapists and nursing staff to base reviews on patient needs.
• Collaborate with ancillary services to prevent delays in care.
• Evaluate the UM program for compliance with regulations, policies and procedures.
• Oversee chart reviews and provide recommendations to physicians on UM issues.
• Provide staff management including hiring, development, training and performance management.

Connaissances

Leadership

Communication

Team collaboration

Regulatory compliance

Formation

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field preferred

Description du poste

Overview

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.