Director of Utilization Onsite

Bowling Green Inn of Brandywine•East Marlborough Township, PA

3d•Onsite

About The Position

Bowling Green Inn at Brandywine is hiring a Director of Utilization to direct and manage the day-to-day operations of the Utilization Review department at its 200-bed alcohol and drug rehabilitation treatment center in Kennett Square, Pennsylvania. This is a 100% onsite role, scheduled Monday through Friday, with weekend availability required. The Director monitors service utilization and reimbursement, oversees patient reviews, coordinates with Medicaid reviewers and clinical staff, and evaluates the utilization management program for regulatory and procedural compliance. The role also includes managing department staff through hiring, development, training, performance management, and communication.

Requirements

Bachelor's degree in nursing or another clinical field required.
Four or more years of experience in utilization management required.
Three or more years of supervisory experience required.
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

Monitor utilization of services and optimize facility reimbursement while maximizing the use of patient provider benefits to meet their needs.
Conduct and oversee concurrent and retrospective reviews for all patients.
Serve as a liaison between Medicaid reviewers and staff completing required paperwork to facilitate the Utilization Review process.
Collaborate with physicians, therapists, and nursing staff to provide reviews suited to 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 specific managed care issues, as needed.
Manage staff, including hiring, development, training, performance management, and communication, to support effective and efficient department operations.
Perform other functions and tasks as assigned.