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 .
- Six or more year's clinical experience with the population of the facility preferred.
- F our or more years ’ experience in utilization management .
- Three or more years of supervisory experience .
- 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 , 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
5,001-10,000 employees
