Director of Utilization
About The Position
Join our team as a Director of Utilization at Yellow Rock Behavioral Health! We are a mission-driven organization dedicated to providing compassionate, high-quality behavioral health services to children and adolescents. We are seeking caring, motivated professionals who are passionate about making a positive impact through person-centered, ethical, and collaborative care. Yellow Rock Behavioral Health is an 102-bed psychiatric residential facility. We've been serving as a beacon of light and a pillar to the families we focus upon, providing exceptional, empirically-validated treatment and support for children, teens, and their families using a multidisciplinary team of medical and mental healthcare professionals. PURPOSE STATEMENT: Direct and manage the day-to-day operations of the Utilization Review department .
Requirements
- Bachelor's Degree in nursing or other clinical field required .
- Six or more year's clinical experience with the population of the facility preferred.
- F our or more years ' experience in utilization management required .
- Three or more years of supervisory experience required .
- If applicable, c urrent 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.
Responsibilities
- 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 review s 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.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
51-100 employees
