Director of Utilization

West Pines Behavioral Hospital • Westminster, CO

14d

About The Position

West Pines Behavioral Hospital is a leading provider of mental health and substance use treatment for Westminster, Colorado, and surrounding communities. With more than three decades of experience and a full continuum of care, we can effectively address a wide range of symptoms and concerns. Through evidence-based treatments and personalized support, we strive to promote wellness, foster healing, and improve the lives of our patients and their families.
​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.

What This Job Offers

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