Utilization Review Director: Lead Clinical Outcomes

Starlite Recovery Center; San Antonio (TX); On-site; USD 110,000 - 160,000; Full time

Job summary

Starlite Recovery Center in Center Point, Texas, is seeking a Director of Utilization to lead the Utilization Review department and optimize patient care and reimbursement processes.

The role reports to senior leadership, oversees concurrent and retrospective reviews, ensures regulatory compliance, and develops staff through hiring, training, and performance management to maintain an efficient operations workflow.

Qualifications

• Bachelor's Degree in nursing or other clinical field required.
• Master's Degree in clinical field preferred.
• Six or more year's clinical experience with the population of the facility preferred.
• Four or more years' experience in utilization management required.
• Three or more 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 for the facility while maximizing use of the patient's provider benefits for their needs.
• Conducts and oversees concurrent and retrospective reviews for all patients.
• Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
• Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
• Collaborates with ancillary services in order to prevent delays in services.
• Evaluates the UM program for compliance with regulations, policies and procedures.
• May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
• Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
• Perform other functions and tasks as assigned.

Skills

Supervisory experience

Staff management

Utilization management

Regulatory compliance

Education

Bachelor's degree in nursing or clinical field

Master's degree in clinical field

Job description

Starlite Recovery Center in Center Point, Texas, is seeking a Director of Utilization to lead the Utilization Review department and optimize patient care and reimbursement processes.

The role reports to senior leadership, oversees concurrent and retrospective reviews, ensures regulatory compliance, and develops staff through hiring, training, and performance management to maintain an efficient operations workflow.