Director of Utilization

Ohio Hospital for Psychiatry•Columbus, OH

3d•Onsite

About The Position

Ohio Hospital for Psychiatry is seeking a Director of Utilization to join its leadership team and support patients receiving specialized psychiatric care. The hospital is a 130-bed acute care facility in Columbus, Ohio, offering adult and senior inpatient programs, dual diagnosis programs, and intensive outpatient programs. The Director directs and manages the day-to-day operations of the Utilization Review department. The role monitors service utilization and reimbursement, oversees patient reviews, coordinates the utilization review process with Medicaid reviewers and clinical staff, and evaluates the utilization management program for regulatory and procedural compliance. The Director also manages department staff, including hiring, development, training, and performance management.

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 patient population preferred.

Responsibilities

Direct and manage the day-to-day operations of the Utilization Review department.
Monitor utilization of services and optimize facility reimbursement while maximizing use of patients’ provider benefits for their needs.
Conduct and oversee concurrent and retrospective reviews for all patients.
Act 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 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 specific managed care issues, as applicable.
Manage staff, including hiring, development, training, performance management, and communication, to support effective and efficient department operations.
Perform other functions and tasks as assigned.