Director of Utilization & Care Optimization

Acadia Healthcare; Boerne (TX); On-site; USD 120,000 - 160,000; Full time

Job summary

Starlite Recovery Center in Center Point, Texas, is seeking a Director of Utilization to lead the Utilization Review department and ensure compliant, efficient patient care. The role includes overseeing concurrent and retrospective reviews, liaising with Medicaid, collaborating with physicians and nursing staff, and developing staff to sustain high-quality utilization management.

The candidate should hold a nursing or clinical degree with substantial experience in utilization management and

Qualifications

• Bachelor's Degree in nursing or clinical field required.
• Master's Degree in clinical field preferred.
• 6+ years clinical experience with the population of the facility preferred.
• 4+ years experience in utilization management required.
• 3+ years of supervisory experience required.

Responsibilities

• Monitor utilization of services and optimize reimbursement for the facility.
• Conduct concurrent and retrospective reviews for all patients.
• Act as a liaison between Medicaid reviewers and staff for required paperwork.
• Collaborate with physicians, therapists and nursing staff to provide optimal review material.
• Collaborate with ancillary services to prevent delays in services.
• Evaluate the UM program for compliance with regulations, policies and procedures.
• Review charts and make recommendations to physicians on utilization review issues.
• Provide staff management including hiring, development, training, and performance management.

Skills

Supervisory experience

Utilization management

Clinical collaboration

Staff development

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field preferred

Job description

Starlite Recovery Center in Center Point, Texas, is seeking a Director of Utilization to lead the Utilization Review department and ensure compliant, efficient patient care. The role includes overseeing concurrent and retrospective reviews, liaising with Medicaid, collaborating with physicians and nursing staff, and developing staff to sustain high-quality utilization management.

The candidate should hold a nursing or clinical degree with substantial experience in utilization management and