Dir - Utilization Review/Mgmt
Job in
Orlando, Orange County, Florida, 32885, USA
Listing for:
La Amistad Behavioral Health Services
Full Time
position
Listed on 2026-10-09
Job specializations:
-
Healthcare
Healthcare Management
-
Management
Healthcare Management
Salary/Wage Range or Industry Benchmark: 100000 - 140000 USD Yearly
USD
100000.00
140000.00
YEAR
Job Description & How to Apply Below
Position: DIR - UTILIZATION REVIEW / MGMT
Responsibilities
La Amistad Behavioral Health Services is a leader in the field of behavioral health care, and our experts are committed to providing the highest quality of care in an atmosphere that nurtures healing and growth. La Amistad enjoys full accreditation by The Joint Commission. La Amistad believes in building healthy communities, which start with healthy individuals, linked through sound relationships to their families, friends, neighbors and peers.
Director of Utilization Review:
Directs and coordinates the utilization review process. Supervises Utilization Review staff. Assures optimum quality of patient care in the most cost-effective manner. Assists in performing admission and continued-stay reviews. Works with the Physicians and the Social Services department to ensure quality of documentation of patient care. Identifies Utilization Review problems. Coordinates and maintains data for use of leadership team.
Program Planning and Treatment
Direct the response to request for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiating of services, and follow up activity.Review the effectiveness of the comprehensive interface with external reviewers, communicate with external reviewers and managed care organizations to assure timely and appropriate interactions, monitor outcomes of reviews and provide consultation as needed.Review the quality of documentation provided at all levels of care to assure adequacy and clinical appropriateness.Assure patients are receiving effective and appropriate treatment, based on the level of care.Establish standards for customer relations and monitor the interactions between Utilization Review staff and customers to evaluate the effectiveness of customer service.Direct the program services offered, consulting with facility management in the planning, development, implementation and evaluation of the utilization review program.Maintain current awareness of mental health activities in the communityMaintain an awareness of community and market-related activities which includes knowledge of the activities of other providers, needs of local payers and the political climate related to mental healthParticipate in clinical team analysis and evaluation of current services offered at the facilityStrategically solve problems that encompass the larger view of the organization, and establish goals by utilizing an understanding of organizational dynamics in planning and problem solving.Remain current on all clinical techniques, and provide direction to staff and facility personnel.Participate in developing, justifying and controlling the annual budget for department personnel, facilities and equipment.Ensure strategic program goals and objectives are consistent with overall facility goals and objectives.Develop goals and objectives, policies and procedures related to the operational needs of the programs scenarios.Consult with facility management in the development and facilitation of program activities which assure an optimal therapeutic experience for all patientsParticipate with ensuring that individual patients and their families are involved in the development of individualized treatment plans..Maintain an active involvement and awareness of all patient admissions, discharges and transfers.Meet regularly with program managers and the Medical Director and program staff to ensure compliance with program goals and objectives.Serve on Facility Committees and attend meetings as assigned.Provide services to current referral sources to assure their satisfaction and continued associations.Develop and maintain a system to minimize and address denials in consult with the facility Business Office Manager and CFO.Personnel Management and Staffing
Maintain and allocate a well qualified core of staff resources.Assure that hiring, disciplinary actions and termination procedures are conducted in accordance with hospital policies.Involve appropriate facility management in all decisions, and review these decisions with COO prior to implementation.Assure adequate supervision and evaluation processes for all staff members and delegate these responsibilities as appropriate.Assure adequate orientation for new employees of the Utilization Review Department.Provide for educational needs and professional development of staff.Ensure that the staff schedule and configuration will meet the needs and demands of the patient population and…
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