Director of Utilization Review & Care Coordination

Acadia Healthcare; Kennett Square (Chester County); On-site; USD 90,000 - 130,000; Full time

Job summary

Acadia Healthcare in Kennett Square, PA seeks a leader to direct and manage the Utilization Review department. Responsibilities include monitoring service utilization, optimizing reimbursement, and coordinating with Medicaid reviewers to ensure compliant, timely reviews.

The role requires a clinical background with supervision experience. Collaboration with physicians, nursing staff, and ancillary services is essential to prevent delays and improve patient outcomes.

Qualifications

• Bachelor's degree in nursing or a clinical field required; Master's degree preferred.
• 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 for the facility while maximizing patient provider benefits.
• Conduct concurrent and retrospective reviews for all patients.
• Act as liaison between Medicaid reviewers and staff to facilitate the Utilization Review process.
• Collaborate with physicians, therapists, and nursing staff to provide optimal review.
• Collaborate with ancillary services to prevent delays in services.
• Evaluate the UM program for regulatory compliance.
• Review charts and make recommendations to physicians on utilization review and managed care issues.
• Provide staff management including hiring, development, training, performance management and communication.

Skills

Staff management

Hiring

Training

Performance management

Communication

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field (preferred)

Job description

Acadia Healthcare in Kennett Square, PA seeks a leader to direct and manage the Utilization Review department. Responsibilities include monitoring service utilization, optimizing reimbursement, and coordinating with Medicaid reviewers to ensure compliant, timely reviews.

The role requires a clinical background with supervision experience. Collaboration with physicians, nursing staff, and ancillary services is essential to prevent delays and improve patient outcomes.