Utilization Review Director

1 month 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 month 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 Management Specialist

    3 weeks ago

    Fort Wayne, Indiana, United States Northern Path Recovery Center Full time

    Northern Path Recovery Center Seeks Director of Utilization ReviewEstimated Salary: $78,500 - $92,000 per yearThe Director of Utilization Management is responsible for overseeing the Utilization Management department at Northern Path Recovery Center. This on-site position involves leading and facilitating review of assigned admissions, continued stays,...

  • Director – Engineering, Maintenance

    2 weeks ago

    Fort Wayne, IN, United States Zoetis Spain SL Full time

    Director – Engineering, Maintenance & Utilities Zoetis, a world leader in animal health is looking to fill a Director – Engineering, Maintenance and Utilities position in Lincoln, Nebraska. Zoetis is a global animal health company dedicated to serving veterinarians, livestock producers and people who raise and care for farm and companion animals in more...

  • Hospital Director

    6 days ago

    Fort Wayne, United States Ethos Veterinary Health Full time

    Hospital Director The Northeast Indiana Veterinary Emergency & Specialty Hospital (NIVES) has provided the highest level of specialized small animal health care to our community since 2004. We grew out of a well-established, AAHA accredited, primary care clinic originally started in this location in 1967. Over the past 20 years, we have grown into one of the...

  • CL-4.2 Finance/Utility Secretary

    1 month 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-Rehab PT

    7 days ago

    Wayne, United States PowerBack Rehabilitation Full time

    Overview: At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent...

  • Hotel Profitability Director

    2 weeks ago

    Fort Wayne, Indiana, United States Hampton Inn Fort Wayne Full time

    Job DescriptionWe are seeking an experienced Hotel Profitability Director to join our team at Hampton Inn Fort Wayne. As a key member of our operations management team, you will be responsible for driving hotel profitability through revenue generation, cost control, and guest satisfaction.Responsibilities:Conduct daily HHBR meetings with the Director of...

  • Director-Rehab PT

    3 days ago

    Wayne, United States Powerback Rehabilitation Full time

    Overview: At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and...

  • Director-Rehab PT

    3 days ago

    Wayne, United States Powerback Rehabilitation Full time

    Overview: At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and...

  • Utilization Review

    1 week ago

    Fort Lauderdale, United States Robert Half Full time

    Job DescriptionJob DescriptionWe are offering a contract for a Utilization Review (UR) Records Analyst (ABA) position in Lauderdale Lakes, Florida. This role is primarily within the healthcare industry and requires the successful candidate to be physically present in the office. The primary function of this role is to handle customer applications, maintain...

  • Ethos Veterinary Health | Hospital Director

    6 days ago

    fort wayne, United States Ethos Veterinary Health Full time

    Hospital Director The Northeast Indiana Veterinary Emergency & Specialty Hospital (NIVES) has provided the highest level of specialized small animal health care to our community since 2004. We grew out of a well-established, AAHA accredited, primary care clinic originally started in this location in 1967. Over the past 20 years, we have grown into one of the...

  • Utilization Review Specialist

    2 weeks ago

    Fort Worth, United States WellBridge Healthcare Full time

    Description*Utilization Review Specialist (URS) - Behavioral Health*WellBridge Fort Worth, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate...

  • Utilization Review Specialist

    2 weeks ago

    Fort Worth, United States WellBridge Healthcare Full time

    Description *Utilization Review Specialist (URS) - Behavioral Health* WellBridge Fort Worth, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in...

  • Utilization Review Specialist

    3 weeks ago

    Fort Worth, United States WellBridge Healthcare Full time

    Job DescriptionDescription*Utilization Review Specialist (URS) - Behavioral Health*WellBridge Fort Worth, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in...

  • Utilization Review Specialist

    3 weeks ago

    Fort Worth, United States WellBridge Healthcare Full time

    Job DescriptionDescriptionUtilization Review Specialist (URS) - Behavioral HealthWellBridge Fort Worth, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in...

  • Utilization Review Specialist

    2 weeks ago

    FORT WORTH, United States WellBridge Healthcare Full time

    Description*Utilization Review Specialist (URS) - Behavioral Health* WellBridge Fort Worth, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate...

  • Automotive Operations Director

    6 days ago

    Fort Wayne, Indiana, United States Gerber Collision & Glass Full time

    Job Title: Automotive Operations DirectorWe are seeking an experienced Automotive Operations Director to lead our collision repair center in providing exceptional customer experiences. The ideal candidate will have a proven track record of success in a collision repair environment, with strong leadership and communication skills.Key Responsibilities:Lead...

  • Director, Facilities Management, Full Time

    3 days ago

    Wayne, United States Powerback Rehabilitation Full time

    As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home-based care. If...

  • Director of Facilities Management Full Time

    3 days ago

    Wayne, United States Powerback Rehabilitation Full time

    As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school. With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home-based care. If...

  • Director of Rehabilitation

    4 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...