0000 Facility - Director of Utilization

Acadia Healthcare • Columbus, OH

13h

About The Position

Directs and manages the day-to-day operations of the Utilization Review department. The role monitors service utilization and seeks to optimize facility reimbursement while maximizing use of patients’ provider benefits to meet their needs. The Director conducts and oversees concurrent and retrospective reviews, coordinates with Medicaid reviewers and facility staff, and collaborates with physicians, therapists, nursing staff, and ancillary services to support appropriate reviews and prevent service delays. The position also evaluates the Utilization Management program for compliance and provides staff management to support effective department operations.

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.
• If applicable, current licensure as an LPN or RN in the state where the facility provides services, or a current clinical professional license or certification 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

• Monitor service utilization and optimize facility reimbursement while maximizing use of patients’ provider benefits for their needs.
• 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 specific managed care issues, as needed.
• Manage staff, including hiring, development, training, performance management, and communication, to ensure effective and efficient department operations.
• Perform other functions and tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Director