Director of Utilization Onsite

Acadia Healthcare; Kennett Square (Chester County); On-site; USD 90,000 - 140,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

HSA and FSA options

Company-paid Life & AD&D insurance

Disability benefits

401(k) with company match

EAP and Employee Discount Program

Paid Holidays

PTO

Tuition Reimbursement

Job summary

Bowling Green Inn at Brandywine in Kennett Square, PA seeks a Director of Utilization to lead the Utilization Review department on-site. You will oversee concurrent and retrospective reviews, coordinate with Medicaid reviewers, and work with physicians, therapists, and nursing staff to ensure appropriate patient utilization and reimbursement strategies.

The role requires clinical leadership with 4+ years in utilization management, supervisory experience, and a relevant nursing/clinical degree.

Qualifications

• Bachelor's Degree in nursing or other clinical field required.
• Master's Degree in clinical field preferred.
• Six or more years' clinical experience with the population served preferred.
• Four or more years’ experience in utilization management required.
• Three or more years of supervisory experience required.

Responsibilities

• Monitor utilization of services and optimize reimbursement for the facility while ensuring appropriate patient benefit usage.
• Conduct concurrent and retrospective reviews for all patients.
• Act as liaison between Medicaid reviewers and staff to facilitate Utilization Review.
• Collaborates with physicians, therapists and nursing staff to provide optimal review based on patient needs.
• Collaborates with ancillary services to prevent delays in services.
• Evaluate the UM program for compliance with regulations, policies and procedures.
• Provide staff management including hiring, development, training and performance management.

Skills

Utilization management

Supervisory experience

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field

Job description

Overview

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 Brandywineoffers 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

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 toprovidingequalemploymentopportunitiestoall applicantsforemploymentregardlessofanindividual’scharacteristicsprotected byapplicable state,federalandlocallaws.

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