Director of Utilization Onsite

Acadia Healthcare; Center Point (TX); On-site; USD 90,000 - 130,000; Full time

Job summary

Starlite Recovery Center seeks a Director of Utilization to lead the Utilization Review team at its Center Point, TX campus. The role directs day-to-day operations, oversees concurrent and retrospective reviews, and collaborates with physicians, therapists, and nursing to optimize patient-care reviews.

The position requires nursing or clinical field expertise with 6+ years in clinical settings, 4+ years in utilization management, and 3+ years in supervisory roles.

Qualifications

• Bachelor's degree required in nursing or clinical field.
• Master's degree in clinical field preferred.
• Six+ years clinical experience with the facility population.
• Four+ years in utilization management.
• Three+ years supervisory experience.

Responsibilities

• Direct and manage day-to-day Utilization Review operations.
• Monitor utilization of services and optimize reimbursement.
• Oversee concurrent and retrospective reviews for all patients.
• Serve as liaison with Medicaid reviewers and staff.
• Collaborate with physicians, therapists, and nursing to optimize reviews.
• Coordinate with ancillary services to prevent delays.
• Evaluate UM program for regulatory compliance.
• Provide staff management including hiring and development.
• Perform other tasks as assigned.

Skills

Utilization management

Staff supervision

Interdisciplinary collaboration

Clinical excellence

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field (preferred)

Job description

Overview

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.

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 to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.