Director of Utilization Management & Payer Relations

Oceans Healthcare; Shreveport (LA); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) Match

Tuition Reimbursement

Daily Pay

Paid Time Off

Competitive Pay

Disability Insurance

Life Insurance

Employee Assistance

Job summary

Oceans Healthcare seeks a Director of Utilization Management to lead and optimize utilization review across inpatient, partial hospitalization, and outpatient programs. You will audit records, ensure timely discharge planning, and align activities with Joint Commission and state requirements.

You will coordinate with physicians, staff, and third-party payers, oversee pre-certification and ongoing certifications, and drive cost-effective, high-quality care.

Qualifications

• Bachelor's degree in social services or nursing or equivalent work experience.
• At least two years psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
• At least two years of supervisory experience.

Responsibilities

• Oversee utilization management for inpatient, partial hospitalization, and outpatient programs.
• Audit medical records for admission criteria and discharge planning.
• Coordinate with third-party payers and clinical staff.
• Communicate with care team to document level and intensity of service.
• Ensure compliance with Joint Commission, state regulations and Oceans policies.
• Report findings and corrective actions to PI Coordinator and committees.
• Coordinate communications between physicians, staff and payers for reimbursement.
• Attend daily/weekly meetings for payer pre-certification and ongoing requirements.
• Manage reimbursement denials appeals and notify patients of HINN notices.
• Support new managed care contracts and renewal communications.

Skills

Communication

Leadership

Organizational skills

Data analysis

Patient advocacy

Regulatory knowledge

UM processes

Discharge planning

Education

Bachelor's degree in social services or nursing

2+ years psychiatric/chemical dependency experience

2+ years supervisory experience

Tools

Outlook

Excel

PowerPoint

Word

Job description

Oceans Healthcare seeks a Director of Utilization Management to lead and optimize utilization review across inpatient, partial hospitalization, and outpatient programs. You will audit records, ensure timely discharge planning, and align activities with Joint Commission and state requirements.

You will coordinate with physicians, staff, and third-party payers, oversee pre-certification and ongoing certifications, and drive cost-effective, high-quality care.