Director of Admissions and Utilization Review

2 weeks ago

New Brighton, Minnesota, United States Meridian Behavioral Health Full time

The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned.

  • Leads, supervises and directs the workload in the department and with associated stakeholders review and access payer reports as they pertain to the utilization of days, level of care, services and reimbursement.
  • Performs continuing contract pricing and managed care strategy in the market such as: development, implementation and monitoring of clinical guidelines to determine the appropriateness of admissions, procedures and the necessity of continued care
  • Oversees and ensures all monthly Accentra requests are completed in a timely manner. Addresses any issues that may arise with those submissions.
  • Required to become familiar with the clinical and medical team, including program director and all staff to ensure a cohesive daily working knowledge and an understanding of the various programs, levels of care and service development as well as the service line expansion.
  • Required to become familiar with 245G statute and associated organizational requirements.
  • Maintains and builds relationships with stakeholders, including commercial and Medicaid payors.
  • Works with VP of Clinical Services to develop and identify measurable departmental goals and outcomes; tracks and manages progress for short and long term business success.
  • Work with program Directors to review and access payer reports as they pertain to the utilization of days, level of care, services and reimbursement.
  • Provide strategic direction and leadership in the development, implementation and maintenance of effective processes, procedures, systems and metrics of the Access, Intake and Utilization Review department, known as Admissions.
  • Assist Clinical Director in orienting and training all new staff for aspects of their roles associated with access, intake, and utilization review.
  • Works with department supervisors to prepare and lead training to ensure staff are prepared for all aspects of the job and expectations of growth.
  • Intervene on cases as-needed; May work with a small case load of clients as needed.
  • Will manage daily census and admission reports and report weekly status to management on client's stay length, admissions, discharges and any funding.
  • Will report weekly status to management on intake, client's length of stay, admissions, discharges and funding.
  • Will work in conjunction with the Executive Leadership Team to develop medical staff trainings and in-services to cultivate strong, trustworthy work relations with all medical and clinical staff
  • Attend treatment team meetings on a as needed basis for each facility and provide support to department staff to include training

Education and Experience qualifications: Four (4) years of experience in field of Chemical Dependency/Mental Health, Healthcare and/or Human Services;

  • This position requires graduation from a recognized college or university with a bachelor's degree in business, hospital administration, social work, public health or related field. A Master's degree is preferred.
  • At least seven to ten years of experience with progressive responsibility in a healthcare environment, (at least five of which should be in a managed care/clinical position with demonstrated competencies or an equivalent combination of experience and education). A thorough understanding of the healthcare market, managed care, physician organizations, and knowledge of relevant state and federal regulations is mandatory
  • Must be free from chemical/ alcohol dependency for a continuous period of at least 2 years.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR c)

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