Director of Utilization Onsite

Acadia•East Marlborough Township, PA

3d•Onsite

About The Position

Bowling Green Inn at Brandywine is seeking a Director of Utilization to direct and manage the day-to-day operations of its Utilization Review department. This is a 100% onsite role at a 200-bed alcohol and drug rehabilitation treatment center in Kennett Square, Pennsylvania. The schedule is Monday through Friday, with weekend availability. The Director monitors service utilization and optimizes facility reimbursement while maximizing the use of patients’ provider benefits. The role oversees concurrent and retrospective patient reviews, coordinates with Medicaid reviewers and facility staff on required paperwork, and collaborates with physicians, therapists, nursing staff, and ancillary services to support patient needs and prevent delays. The Director also evaluates the utilization management program for compliance and may review charts and recommend actions to physicians regarding utilization review and managed care issues. The position provides staff management, including hiring, development, training, performance management, and communication to support effective department operations. A bachelor’s degree in nursing or another clinical field is required; a master’s degree in a clinical field is preferred. Four or more years of utilization management experience and three or more years of supervisory experience are required. Six or more years of clinical experience with the facility’s population is preferred. Where applicable, current state licensure or clinical professional certification is required.

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.
Where 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.
Six or more years of clinical experience with the facility’s population.

Responsibilities

Direct and manage the day-to-day operations of the Utilization Review department.
Monitor service utilization and optimize facility reimbursement while maximizing use of patients’ 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.