0000 Facility - Director of Utilization

Ohio Hospital for Psychiatry • Columbus, OH

2d • $82,000 - $88,000

About The Position

The Director of Utilization directs and manages the day-to-day operations of the Utilization Review department. The role monitors service utilization and reimbursement, oversees concurrent and retrospective patient reviews, and coordinates with Medicaid reviewers, physicians, therapists, nursing staff, and ancillary services. It also evaluates the utilization management program for compliance and provides staff management, including hiring, development, training, performance management, and communication. The schedule is Monday through Friday, days, and the stated annual salary range is $82,000 to $88,000.

Requirements

• Bachelor’s degree in nursing or another clinical field.
• At least four years of experience in utilization management.
• At least three years of supervisory experience.
• 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.
• Six or more years of clinical experience with the facility’s population.

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 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.

What This Job Offers

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