Utilization Review Director

1 week ago

fort wayne, United States Northern Path Recovery Center Full time

**This on site position, NOT remote**

Salary Range: $73-85k


The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria. Directs and manages the day-to-day operations and supervision of staff to obtain coverage for clients, monitors the progress of all UR cases and insurance appeals, problem solves when necessary and mitigates all issues with utilization. Monitors utilization of services and optimizes reimbursement for the facility while maximizing use of the client’s provider benefits for their needs.


EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

  • Graduation from an accredited school of nursing OR a Bachelor's degree in social work, behavioral or mental health, or other related health field required. Master's Degree in same field preferred.
  • Six or more year's clinical experience with the substance use disorder population required.
  • Four or more years’ experience in medical/psychiatric utilization management required.
  • Minimum of three years supervisory experience in clinical setting/utilization required.
  • Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using the established facility criteria.
  • Ability to communicate professionally and effectively with multidisciplinary team members, managed care organizations and business office, providing needed information in a logical, concise manner using technical language that accurately describes client’s condition.


LICENSES/DESIGNATIONS/CERTIFICATIONS:

· CPR and de-escalation certification required (training available upon hire and offered by facility).

· First aid may be required based on state or facility requirements.


ESSENTIAL FUNCTIONS:

· Assigns all clients to Utilization Review staff and supervises staff to ensure staff are completing insurance verifications on time and compliant with regulatory standards and requirements.

· Ensures staff are competent to review medical records of clients for appropriateness of level of care at admission and at intervals determined by documentation in medical record and to communicate client insurance status and needs with all disciplines.

· Leads a team of highly engaged members thru hiring, orienting, performance assessment and

management, motivating, training, scheduling, and coaching to meet department goals and ensure effective and efficient department operation.

· Works closely with Admissions Department to ensure client information is accurate and pre-certification is complete. Reviews application for client admission and approves admission or refers case to utilization review committee for review and course of action when case fails to meet admission standards.

· Manages any discrepancies regarding stated benefit information and insurance verification, need for updated benefits or follow-up on a problem with a pre-certification from admissions.

· Appeals all denials ensuring accuracy of information and effective coordination of correspondence.

· Analyzes client records to determine appropriateness of admission, treatment, and length of stay to comply with government and insurance company reimbursement policies. Ensures charting deficiencies are minimized and corrected timely by responsible staff. Identifies and forwards charts for review based on outlying data to the Medical Director.

· Analyzes insurance, governmental and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of clients.

· Compares client’s medical records to established criteria and confers with medical, clinical, nursing, and other professional staff to determine appropriateness of treatment and length of stay. Communicates and coordinates information with business office to recognize and resolve potential payment issues.

· Conducts and oversees concurrent and retrospective reviews for all clients. Assists review committee in planning and holding mandated quality assurance reviews.

· Acts as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process

  • Utilization Review Director

    1 week ago

    Fort Wayne, United States Northern Path Recovery Center Full time

    **This on site position, NOT remote**Salary Range: $73-85k The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria. Directs and manages the...

  • Utilization Review Director

    1 week ago

    Fort Wayne, United States Northern Path Recovery Center Full time

    **This on site position, NOT remote**Salary Range: $73-85k The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria. Directs and manages the...

  • Utilization Review Nurse

    1 month ago

    Fort Lauderdale, Florida, United States Trinity Health Full time

    Job Summary:As a Utilization Review Nurse at Trinity Health, you will play a vital role in ensuring that patients receive appropriate care while managing healthcare costs effectively. You will assess patient care plans and medical records to verify the necessity and effectiveness of treatments being proposed or provided. Your expertise will help determine...

  • Area Director

    2 months ago

    Fort Wayne, United States Caregiver Full time

    The Area Director is responsible for planning, directing, coordinating, organizing and implementing the systems, processes and programs needed to provide services to individuals served ensuring services meet State licensing standards and contract obligations, level of service and program model. Ensures that the program and all personnel represent the...

  • Utilization Review Nurse

    4 weeks ago

    Fort Lauderdale, Florida, United States Holy Cross Hospital Full time

    Job Summary: We are seeking a skilled Utilization Review Nurse to join our team at Holy Cross Hospital in Fort Lauderdale, Florida. The successful candidate will have well-developed knowledge and skills in areas of utilization management, medical necessity, and patient status determination. Key Responsibilities: * Assess patient care plans and medical...

  • Utility Coordinator

    1 month ago

    Fort Wayne, Indiana, United States DLZ Full time

    Job Title: Utility CoordinatorDLZ Corporation is a leading architecture and engineering firm serving public and private entities across the nation. As a multidisciplinary firm, DLZ provides engineering and architectural design services, construction management, surveying, right-of-way acquisition, and materials testing.Our mission is to build on our...

  • Utility Coordinator

    4 months ago

    Fort Wayne, United States DLZ Full time

    DLZ Corporation is an award-winning architecture and engineering firm serving public and private entities across the nation. As a multidisciplinary firm, DLZ provides engineering and architectural design services, construction management, surveying, right-of-way acquisition and materials testing. In 2016, DLZ was named Design Firm of the Year by...

  • Utilization Review RN

    3 weeks ago

    Fort Lauderdale, United States Trinity Health Full time

    Employment Type: Part time Shift: Description: The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or maintaining effective and efficient processes for determining the appropriate...

  • CL-4.2 Finance/Utility Secretary

    3 days ago

    Wayne, United States Wayne County Regional Educational Service Agency Full time

    CL-4.2 Finance Utility Secretary Role and Responsibilities 60% of Duties to Director of Finance Scan and upload all invoices to the JE module for benefit tracking Time Entry for Payroll for all Central Office, Grant Related activities & Student Tech. Secretary, Utility, Finance, Finance Director, Banking, Education

  • Director of Financial Operations

    4 weeks ago

    Fort Wayne, Indiana, United States Southeastern College Full time

    The purpose of Southeastern College is to offer quality career education in an atmosphere of personalized attention. At Southeastern College, we focus on the specialized skills and knowledge needed for today's marketplace by providing courses that apply to skill performance and career management development.Our faculty consists of industry-experienced...

  • Director of Rehabilitation

    3 months ago

    Fort Wayne, United States Reliant Rehabilitation Full time

    Overview: When you join Reliants therapy team, you join a team that makes a very real impact in the lives of the patients and residents we serve. As a leading rehab therapy provider for skilled nursing facilities (SNFs), Reliant therapists provide necessary rehabilitation services for our most vulnerable population. As a Reliant therapist, you also have the...

  • Digital Media Director

    6 months ago

    Fort Wayne, United States Deploy Alloy Full time

    About the job Digital Media Director DIGITAL MEDIA DIRECTOR The Digital Media Director is a key leadership role responsible for overseeing and implementing digital media strategies for the agency. The role involves managing and optimizing various digital media channels to drive brand awareness, engagement, and conversions. The Digital Media Director...

  • Digital Media Director

    3 weeks ago

    Fort Wayne, United States Deploy Alloy Full time

    About the job Digital Media Director DIGITAL MEDIA DIRECTOR The Digital Media Director is a key leadership role responsible for overseeing and implementing digital media strategies for the agency. The role involves managing and optimizing various digital media channels to drive brand awareness, engagement, and conversions. The Digital Media Director...

  • Center Operations Director

    2 weeks ago

    Fort Wayne, United States Circle City ABA Full time

    Description CIRCLE CITY ABA: Circle City ABA provides Applied Behavior Analysis Therapy for children and adolescents diagnosed with Autism Spectrum Disorder. Circle City ABA has created a center-based environment where play meets progress through high-quality therapy, individualized treatment and behavior plans, and specialized programs. The mission of...

  • Insurance Defense Litigation Attorney

    3 weeks ago

    Fort Lauderdale, Florida, United States Denovo Review Full time

    Job DetailsDenovo Review is seeking an ambitious attorney for its Ft Lauderdale office. The ideal candidate must have a passion for insurance defense litigation.Manage significant caseload from inception to post-trial.Attend hearings, depositions, mediations, and trials.Prepare pleadings, discovery/discovery responses, motions, and other litigation...

  • Director of Nursing

    3 weeks ago

    Fort Wayne, United States Cedar Creek of Fort Wayne Full time

    Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Fort Wayne community.As the Director of Nursing, you will have the opportunity to connect with, and positively impact the lives of, our residents daily! You will be...

  • Property Operations

    2 days ago

    Wayne, United States firstPRO, Inc Full time

    Property Operations AssociateAre you a detail-oriented professional with a knack for organization and collaboration? Join our team as a Property Operations Associate, where you'll play a key role in mitigating utility conflicts and coordinating relocation efforts for new acquisitions and capital construction projects.What You’ll DoReview plans and exhibits...

  • Digital Media Director

    4 weeks ago

    Fort Wayne, Indiana, United States Deploy Alloy Full time

    About the JobThe Digital Media Director is a key leadership role responsible for overseeing and implementing digital media strategies for Deploy Alloy. This role involves managing and optimizing various digital media channels to drive brand awareness, engagement, and conversions.Key Responsibilities:Digital Media Strategy: Collaborate with the Director of...

  • Director of Nursing

    4 weeks ago

    Fort Wayne, United States Cedar Creek of Fort Wayne Full time

    Cedar Creek of Fort Wayne - Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a Director of Nursing at our Cedar Creek of Fort Wayne community. As the Director of Nursing, you will have the opportunity to connect with, and positively impact the lives of, our...

  • Safety Professional

    4 weeks ago

    Fort Wayne, Indiana, United States Centuri Group, Inc. Full time

    About the Role:We are seeking a highly skilled and experienced Safety Professional to join our team as an Electric Utility Safety Specialist. As a key member of our safety team, you will be responsible for promoting and influencing the Safety, Health, Environmental & Quality (SHEQ) program in field operations.Key Responsibilities:Ensure that Electrical...