Director of Utilization Management & Payer Relations

Oceans Healthcare; Shreveport (LA); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Medical, Dental, Vision Coverage

401(k) Retirement Savings Plan with ?

Tuition Reimbursement

Paid Time Off

Daily Pay

Life Insurance

Job summary

Oceans Healthcare is seeking a Director of Utilization Management to oversee inpatient, partial hospitalization, and outpatient utilization activities. You will supervise the UM department, ensure timely chart reviews, and coordinate payer communications to support appropriate, cost-effective patient care.

Responsibilities include monitoring admissions, discharge planning, and regulatory compliance with Joint Commission and state requirements.

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

• Identify and report inappropriate use of services to ensure high quality patient care.
• Oversee daily reviews of inpatient, partial hospitalization, and outpatient records per UM plan.
• Coordinate communications between physicians, staff, and third-party payers for reimbursement.
• Attend daily and weekly treatment team meetings to discuss pre-certifications and ongoing requirements.
• Coordinate notifications of reimbursement issues and manage denial appeals process.

Skills

Assertive communication

Management & leadership

Organizational skills

Data & documentation

Education

Bachelor's degree in social services or nursing

Supervisory experience

Tools

Outlook

Excel

PowerPoint

Job description

Oceans Healthcare is seeking a Director of Utilization Management to oversee inpatient, partial hospitalization, and outpatient utilization activities. You will supervise the UM department, ensure timely chart reviews, and coordinate payer communications to support appropriate, cost-effective patient care.

Responsibilities include monitoring admissions, discharge planning, and regulatory compliance with Joint Commission and state requirements.