0000 Facility - Director of Utilization

Acadia•Franklin Township, OH

2d•$82,000 - $88,000

About The Position

The Director of Utilization directs and manages the day-to-day operations of the facility’s Utilization Review department. The role monitors service utilization and reimbursement while maximizing use of patients’ provider benefits. It oversees utilization reviews, coordinates with Medicaid reviewers and facility staff, and collaborates with physicians, therapists, nursing staff, and ancillary services to support patient needs and prevent service delays. The Director evaluates program compliance and manages department staff, including hiring, development, training, performance management, and communication. The schedule is Monday through Friday, days. The annual salary range is $82,000–$88,000.

Requirements

Bachelor’s degree in nursing or another clinical field.
Four or more years of experience in utilization management.
Three or more years of supervisory experience.
If applicable, current LPN or RN licensure in the state where the facility provides services, or a current clinical professional license or certification required in that state.

Nice To Haves

Master’s degree in a clinical field preferred.
Six or more years of clinical experience with the facility’s population preferred.

Responsibilities

Direct and manage the day-to-day operations of the Utilization Review department.
Monitor utilization of services and optimize facility reimbursement while maximizing use of patient provider benefits.
Conduct and oversee concurrent and retrospective reviews for all patients.
Liaise between Medicaid reviewers and staff completing required paperwork to facilitate the Utilization Review process.
Collaborate with physicians, therapists, and nursing staff to provide reviews based on patient needs.
Collaborate with ancillary services to prevent delays in services.
Evaluate the utilization management program for compliance with regulations, policies, and procedures.
Review charts and make recommendations to physicians regarding utilization review and managed care issues, as needed.
Manage staff, including hiring, development, training, performance management, and communication.
Perform other functions and tasks as assigned.