Director of Utilization & Reimbursement

Acadia Healthcare; San Antonio (TX); On-site; USD 120,000 - 150,000; Full time

Job summary

Starlite Recovery Center in Center Point, Texas, seeks a Director of Utilization to lead the Utilization Review department. You will oversee daily operations, monitor service utilization, and optimize reimbursements while coordinating with Medicaid reviewers and clinical staff.

The role requires a nursing or clinical degree, 4+ years in utilization management, and 3+ years of supervision. This position focuses on compliant UM practices and staff development within a hospital/center setting.

Qualifications

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

Responsibilities

• Direct and manage day-to-day operations of the Utilization Review department.
• Monitor utilization of services and optimize reimbursement for the facility.
• Conduct concurrent and retrospective reviews for all patients.
• Act as liaison between Medicaid reviewers and staff to facilitate the process.
• Collaborate with physicians, therapists and nursing staff to inform reviews.
• Coordinate with ancillary services to prevent delays in services.
• Evaluate the UM program for regulatory compliance.
• Review charts and provide recommendations on utilization and managed care issues.
• Provide staff management including hiring, development, training and performance management.

Skills

Utilization management

Supervisory experience

Education

Bachelor's degree in nursing or other clinical field

Master's degree in clinical field (preferred)

Job description

Starlite Recovery Center in Center Point, Texas, seeks a Director of Utilization to lead the Utilization Review department. You will oversee daily operations, monitor service utilization, and optimize reimbursements while coordinating with Medicaid reviewers and clinical staff.

The role requires a nursing or clinical degree, 4+ years in utilization management, and 3+ years of supervision. This position focuses on compliant UM practices and staff development within a hospital/center setting.