Strategic Utilization Director

Acadia Healthcare; Kennett Square (Chester County); On-site; USD 90,000 - 120,000; Full time

Job summary

Harboroaks in Kennett Square, PA is seeking a leader to direct and manage the day-to-day operations of the Utilization Review department, ensuring efficient concurrent and retrospective reviews and optimal reimbursement for services.

You will liaise with Medicaid reviewers, collaborate with physicians, therapists and nursing staff, oversee staff development and training, and drive compliance with regulations while maintaining high-quality patient care.

Qualifications

• Bachelor's degree in nursing or a clinical field required.
• Master's degree in a clinical field preferred.
• Six+ years of clinical experience with the population served.
• Four+ years of utilization management experience and three+ years of supervisory experience.

Responsibilities

• Direct and manage day-to-day operations of the Utilization Review department.
• Monitor service utilization and optimize reimbursement while maximizing patient provider benefits.
• Conduct concurrent and retrospective reviews for all patients.
• Liaise between Medicaid reviewers and staff to facilitate the UR process.
• Collaborate with physicians, therapists and nursing staff to base reviews on patient needs.
• Collaborate with ancillary services to prevent delays in care.
• Evaluate the UM program for compliance with regulations, policies and procedures.
• Oversee chart reviews and provide recommendations to physicians on UM issues.
• Provide staff management including hiring, development, training and performance management.

Skills

Leadership

Communication

Team collaboration

Regulatory compliance

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field preferred

Job description

Harboroaks in Kennett Square, PA is seeking a leader to direct and manage the day-to-day operations of the Utilization Review department, ensuring efficient concurrent and retrospective reviews and optimal reimbursement for services.

You will liaise with Medicaid reviewers, collaborate with physicians, therapists and nursing staff, oversee staff development and training, and drive compliance with regulations while maintaining high-quality patient care.