Senior Utilization Review Director
Acadia Healthcare
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Job summary
Acadia Healthcare is seeking an experienced Director to lead the Utilization Review team at a South Hills hospital near Pittsburgh, PA. The role focuses on directing day-to-day UR operations, monitoring service utilization, and ensuring compliant reviews for pediatric/young adult patients with mental health needs.
The position requires a nursing or clinical degree with substantial UR and supervisory experience, and offers visibility across multi-disciplinary teams within the facility.
Qualifications
- Bachelor's degree in nursing or a clinical field required; master's preferred.
- Six+ years of clinical experience with the facility's population.
- Four+ years of utilization management experience.
- Three+ years of supervisory experience.
Responsibilities
- Monitor utilization of services and optimize reimbursement for the facility while leveraging patient benefits.
- Conduct concurrent and retrospective reviews for all patients.
- Serve as liaison between Medicaid reviewers and staff handling required paperwork.
- Collaborate with physicians, therapists and nursing staff to support optimal reviews.
- Coordinate with ancillary services to prevent service delays.
- Evaluate the UM program for regulatory and policy compliance.
- Review charts when needed and make recommendations to physicians on UM issues.
- Oversee staff management including hiring, development, training, and performance management.
Skills
Education
Job description
Acadia Healthcare is seeking an experienced Director to lead the Utilization Review team at a South Hills hospital near Pittsburgh, PA. The role focuses on directing day-to-day UR operations, monitoring service utilization, and ensuring compliant reviews for pediatric/young adult patients with mental health needs.
The position requires a nursing or clinical degree with substantial UR and supervisory experience, and offers visibility across multi-disciplinary teams within the facility.
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