Director of Utilization (100% onsite)

Starlite Recovery Center; Boerne (TX); On-site; USD 110,000 - 150,000; Full time

Job summary

Starlite Recovery Center is seeking a Director of Utilization to lead the Utilization Review department at its Center Point location in the Hill Country, southeast of Kerrville and near Boerne, Texas. The role directs day-to-day operations and collaborates with clinical staff to optimize patient care and reimbursement.

The ideal candidate will have a nursing or clinical background with 6+ years of clinical experience, 4+ years in utilization management, and 3+ years of supervisory experience.

Qualifications

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

Responsibilities

• Direct and manage the day-to-day operations of the Utilization Review department.
• 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.
• Act as a liaison between Medicaid reviewers and staff completing required paperwork to facilitate the Utilization Review process.
• Collaborate with physicians, therapists 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.
• May review charts and make recommendations to physicians regarding utilization review and managed care issues.
• Provide staff management including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

Skills

Leadership

Team Management

Regulatory Knowledge

Utilization Management

Education

Bachelor's Degree in nursing or other clinical field

Master's Degree in clinical field

Tools

RN/LPN licensure

Job description

Starlite Recovery Center has an opportunity to hire a Director of Utilization to join their Amazing Team!

This opportunity is located at Starlite Recovery Center in Center Point, the Hill Country, southeast of Kerrville, and approximately 30 minutes northwest of Boerne, Texas.

Starlite Recovery Center has been treating individuals with Substance Use Disorder for over 67 years.

Purpose Statement

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

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