Director of Utilization Onsite

San Antonio, Texas • San Antonio, TX

3d • Onsite

About The Position

Starlite Recovery Center is hiring a Director of Utilization to direct and manage the day-to-day operations of its Utilization Review department. The role monitors service utilization and reimbursement while maximizing use of patients’ provider benefits in support of their needs. The Director oversees concurrent and retrospective reviews, coordinates the Utilization Review process with Medicaid reviewers and facility staff, and collaborates with physicians, therapists, nursing staff, and ancillary services. The position also evaluates program compliance and provides staff management, including 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 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 support effective and efficient department operations.
• Perform other functions and tasks as assigned.

What This Job Offers

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