Strategic Utilization Review Leader

Acadia Healthcare; El Paso (TX); On-site; USD 85,000 - 105,000; Full time

Job summary

Harboroaks seeks a leader to direct and manage the day-to-day operations of the Utilization Review department, ensuring efficient concurrent and retrospective reviews and optimizing reimbursement.

The role partners with physicians, therapists, and nursing staff and works closely with Medicaid reviewers to deliver timely, patient-centered review decisions while overseeing staff development, training, and performance management.

Qualifications

• Bachelor's degree in nursing or another clinical field required; Master's degree preferred.
• Six or more years of clinical experience with the facility population.
• Four or more years in utilization management.
• Three or more years of supervisory experience.

Responsibilities

• Direct and manage the day-to-day operations of the Utilization Review department.
• Monitor utilization of services and optimize reimbursement for the facility.
• Oversee 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 review decisions.
• Coordinate with ancillary services to prevent delays in services.
• Evaluate the UM program for regulatory compliance and internal policies.
• Provide staff management including hiring, development, training and performance management.

Skills

Staff management

Liaison with Medicaid

Supervisory experience

Collaboration with physicians

Regulatory compliance

Education

Bachelor's Degree in nursing or clinical field

Master's Degree in clinical field

Job description

Harboroaks seeks a leader to direct and manage the day-to-day operations of the Utilization Review department, ensuring efficient concurrent and retrospective reviews and optimizing reimbursement.

The role partners with physicians, therapists, and nursing staff and works closely with Medicaid reviewers to deliver timely, patient-centered review decisions while overseeing staff development, training, and performance management.