Director of Utilization Review

Lifepoint Health • Raleigh, NC

17d

About The Position

Triangle Springs is a behavioral health hospital located in Raleigh, NC. We provide inpatient and outpatient programming for those facing mental health and addiction challenges. Our programs offer caring, compassionate treatment for adults (18+) and include inpatient mental health and addiction treatment and detox, Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).
How you'll contribute
The responsibility of the Utilization Review Director is to ensure the utilization review activities are completed accurately and in a timely manner. This includes the precertification and recertification, peer to peer process, and appeals. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals. The Director will ensure that all UR staff members follow department and facility procedures. The Director will further ensure that communication with all relevant departments, but especially CBO and Business Office, meets staff and patient needs. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals.

Requirements

• Education: Bachelor's degree required. Master's degree preferred.
• Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
• License: Current unencumbered clinical license strongly preferred.
• Additional Requirements: CPI and CPR preferred within 30 days of hire. May be required to work flexible hours.

Responsibilities

• Oversees the UR department, ensuring staff has completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.
• Assists with creation of treatment team agenda and participates to ensure team is aware of coverage info as well as collecting information for communication with insurance or other funding source.
• Be available to educate staff members from other relevant departments on documentation requirements / medical criteria and does so in a professional, organized, and understandable manner.
• Works with DON to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Participates in Administrator on Call rotation.
• Communicate with physicians to schedule peer reviews.
• Accurately report denials.

Benefits

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts
• Competitive paid time off and extended illness bank package for full-time employees
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement, loan assistance, and 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Director