Director of Utilization Review

Job Description

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*Director of Utilization*

To manage and coordinate the Utilization Review process , to assess the medical appropriateness of the care needed and the organization’s course of treatment through gathering and communicating information from and to the clinical treatment team and other necessary individuals. To provide the patient, family and payor assurance of the appropriateness, value and quality of healthcare services being offered. To use current admission criteria and standard review protocols for positively impacting the medical care being delivered and ensuring the most appropriate use of the patient’s benefits.

*Minimum Education*

Bachelor’s Degree in Nursing preferred, or an equivalent combination of education and experience.

*Minimum Work Experience*

RN, MSW, LCSW, MFT, LVN or LPT with at least (3) years of direct clinical experience in psychiatric or behavioral health treatment setting. Outpatient clinical experience highly desirable. Utilization Management/UR or insurance case management experience and familiarity with insurance benefit language required.

*Required License(s):*

RN, MSW, LCSW, MFT, LVN or LPT license required.

*Responsibilities*
* Oversee the utilization review process to ensure quality patient care and compliance with regulations.
* Conduct thorough assessments of medical records and documentation for accuracy and adherence to HIPAA standards.
* Collaborate with healthcare teams to develop and implement effective discharge planning and case management strategies.
* Utilize EMR and EHR systems to track patient progress and optimize care pathways.
* Provide guidance and support to nursing staff and social workers in behavioral health and outpatient settings.

Job Type: Full-time

Pay: $63,000.00 – $80,000.00 per year

Benefits:
* 401(k)
* Dental insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday

Experience:
* Utilization review: 3 years (Preferred)

License/Certification:
* RN (Preferred)

Work Location: In person