Utilization & Care Optimization Director (On-Site)

Bowling Green Brandywine Treatment Center; Kennett Square (Chester County); On-site; USD 95,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

HSA and FSA options

Company-paid Life & AD&D

Disability benefits

401(k) with company match

EAP and employee discounts

Paid holidays

PTO

Tuition reimbursement

Job summary

Bowling Green Inn at Brandywine is seeking a Director of Utilization to lead the Utilization Review department on-site in Kennett Square, PA. The role requires a nursing or clinical background and extensive utilization management experience, with supervisory responsibilities to develop staff and ensure compliant, efficient processes.

The position emphasizes collaboration with physicians, therapists, and nursing staff, plus coordination with Medicaid reviewers to optimize patient care and

Qualifications

• Bachelor's degree in nursing or another clinical field is required.
• 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 while maximizing patient benefits.
• Conduct concurrent and retrospective reviews for all patients.
• Act as liaison between Medicaid reviewers and staff for required paperwork.
• Collaborate with physicians, therapists and nursing staff to provide optimal reviews.
• Collaborate with ancillary services to prevent service delays.
• Evaluate the UM program for regulatory compliance.
• Provide staff management including hiring, development, training and performance management.
• Perform other functions and tasks as assigned.

Skills

Clinical experience

Utilization management

Supervisory experience

Education

Bachelor's degree in nursing or clinical field

Master's degree in clinical field (preferred)

Job description

Bowling Green Inn at Brandywine is seeking a Director of Utilization to lead the Utilization Review department on-site in Kennett Square, PA. The role requires a nursing or clinical background and extensive utilization management experience, with supervisory responsibilities to develop staff and ensure compliant, efficient processes.

The position emphasizes collaboration with physicians, therapists, and nursing staff, plus coordination with Medicaid reviewers to optimize patient care and