Facility - Director of Utilization

PURPOSE STATEMENT:

Direct and manage the day-to-day operations of the Utilization Review department.

M-F Days

$82,000- $88,000 Annually

ESSENTIAL FUNCTIONS:

• 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.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
• 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.

LICENSES/DESIGNATIONS/

CERTIFICATIONS:

• 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.

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