Director of Utilization Onsite

Bowling Green Brandywine Treatment Center; Kennett Square (Chester County); On-site; USD 95,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

HSA and FSA options

Company-paid Life & AD&D

Disability benefits

401(k) with company match

EAP and employee discounts

Paid holidays

PTO

Tuition reimbursement

Job summary

Bowling Green Inn at Brandywine is seeking a Director of Utilization to lead the Utilization Review department on-site in Kennett Square, PA. The role requires a nursing or clinical background and extensive utilization management experience, with supervisory responsibilities to develop staff and ensure compliant, efficient processes.

The position emphasizes collaboration with physicians, therapists, and nursing staff, plus coordination with Medicaid reviewers to optimize patient care and

Qualifications

• Bachelor's degree in nursing or another clinical field is required.
• Six+ years of clinical experience with the facility population preferred.
• Four+ years of utilization management experience required.
• Three+ 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 while maximizing patient benefits.
• Conduct concurrent and retrospective reviews for all patients.
• Act as liaison between Medicaid reviewers and staff for required paperwork.
• Collaborate with physicians, therapists and nursing staff to provide optimal reviews.
• Collaborate with ancillary services to prevent service delays.
• Evaluate the UM program for regulatory compliance.
• Provide staff management including hiring, development, training and performance management.
• Perform other functions and tasks as assigned.

Skills

Clinical experience

Utilization management

Supervisory experience

Education

Bachelor's degree in nursing or clinical field

Master's degree in clinical field (preferred)

Job description

Bowling Green Inn at Brandywine is seeking a Director of Utilization to join our team!

100% On-site role in Kennett Square, PA

Located in the scenic and historic countryside of Pennsylvania’s Brandywine River Valley, Bowling Green Inn at Brandywine has been a premier provider of effective chemical dependency treatment for more than 30 years. Bowling Green Brandywine is a 200-bed Alcohol and Drug Rehab Treatment Center in Kennett Square, PA.

Bowling Green Inn at Brandywine offers an extensive array of benefits to our valued team members. Current offerings encompass:

• Medical, Dental, and Vision Insurance coverage
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options
• Company-paid Basic Life & AD&D insurance
• Disability benefits
• 401(k) Retirement Plan with a company match
• Employee Assistance Program (EAP) and Employee Discount Program
• Paid Holidays for work-life balance
• Paid Time Off (PTO)
• Tuition Reimbursement opportunities for career advancement

Purpose Statement

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

Schedule

on site; Monday - Friday with weekend availability

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.