Director of Utilization

Red River Hospital•Wichita Falls, TX

11d

About The Position

Red River Hospital is looking for a Director of Utilization to join their team! Red River Hospital is the leading provider of inpatient and outpatient behavioral healthcare in Wichita Falls, TX. Our treatment services & specialized programs address drug and alcohol addiction and co-occurring mental illness from the adolescent through the geriatrics populations. Red River Hospital offers an extensive array of benefits to our valued team members. Current offerings encompass: Medical, Dental, and Vision Insurance coverage Health Savings Account (HSA) and Flexible Spending Account (FSA) options Company-paid Basic Life & AD&D insurance Disability benefits 401(k) Retirement Plan with a company match Employee Assistance Program (EAP) and Employee Discount Program Paid Holidays for work-life balance Paid Time Off (PTO) Tuition Reimbursement opportunities for career advancement 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.
Four or more years’ experience in utilization management required.
Three or more years of supervisory experience required.
If applicable, current 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 reviews 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.