Utilization Review Director

CommuniCare Health Services; Columbus (OH); On-site; USD 60,000 - 100,000; Full time

Job summary

An established healthcare provider in Columbus, OH is seeking a licensed clinician to lead their Utilization Review team. This pivotal role involves overseeing the Utilization Review Department, ensuring compliance with precertification processes, and maintaining effective communication across departments. The ideal candidate will have a strong background in clinical assessment and treatment planning, with a focus on improving patient care outcomes. Join a dynamic team that values your expertise and offers competitive wages, generous Paid Time Off, and a comprehensive benefits package. If you are passionate about making a difference in behavioral health, this opportunity could be the perfect fit for you.

Benefits

Competitive wages

Paid Time Off

Comprehensive benefits package

Qualifications

• Bachelor’s Degree in Nursing or related field is required.
• Direct clinical experience in psychiatric settings is preferred.

Responsibilities

• Oversee Utilization Review for Inpatient and Outpatient Services.
• Ensure effective communication regarding patient care needs.

Skills

Clinical Assessment

Treatment Planning

Communication Skills

Management Skills

Education

Bachelor’s Degree in Nursing

Master’s Degree in related field

Job description

A Behavioral Health hospital in the Columbus, OH area is recruiting a licensed clinician to lead our Utilization Review team.

The Utilization Review Director oversees the Utilization Review Department for both Inpatient and Outpatient Services. This includes the precertification and recertification process, peer to peer reviews, and appeal. The Utilization Review Director will ensure an appropriate discharge plan is in place for each patient discharge. The Director will accurately report the authorization status of patients and denials and appeals status to the CEO, CFO, and Business Office staff. The Director will ensure all Utilization Review staff follow department and facility procedures and ensure effective communication with all relevant departments regarding patient care needs.

Our company offers competitive wages, Paid Time Off packages, and a full, robust benefits package.

Qualifications:

1. Education: Bachelor’s Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field required; Master’s Degree preferred.
2. Work Experience: Direct clinical experience in a psychiatric or mental health treatment setting, including managing a related function preferred. Experience in patient assessment, family motivation, treatment planning, and communication with external review organizations or comparable entities.