Director of Utilization

Acadia • San Rafael, CA

11d • $105,000 - $130,000

About The Position

Bayside Marin is a drug rehabilitation program that can accommodate 30 residents in two high-end residential estates. The program emphasizes a personalized and empowering treatment experience by tailoring treatment plans to individual client challenges. The facility is seeking a Director of Utilization Review to lead utilization management processes. This role is crucial for supporting appropriate care delivery, ensuring regulatory compliance, and optimizing the use of patient benefits. The Director will collaborate closely with clinical leadership and external reviewers to ensure timely reviews, maximize reimbursement, and uphold high standards of care.

Requirements

• Bachelor's Degree in nursing or other clinical field required.
• Four or more years’ experience in utilization management required.
• Three or more years of supervisory experience required.
• If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

Nice To Haves

• Master's Degree in clinical field preferred.
• Six or more year's clinical experience with the population of the facility preferred.

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.
• Conduct and oversee 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.
• Collaborate with physicians, therapists, and nursing staff to provide optimal review based on patient needs.
• Collaborate with ancillary services in order to prevent delays in services.
• Evaluate the UM program for compliance with regulations, policies, and procedures.
• Review charts and make necessary recommendations to physicians regarding utilization review and specific managed care issues.
• Provide staff management, including hiring, development, training, performance management, and communication, to ensure effective and efficient department operation.
• Perform other functions and tasks as assigned.

Benefits

• Equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

What This Job Offers

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