Director of Utilization Review

company

The organization strives toward being one of the top behavioral healthcare organizations in the U.S. Our goal at each treatment center is to help our patients overcome their personal challenges and create a positive environment through compassionate caregivers, family, and friends that allow patients to regain control of their life during and after treatment. Each of our unique locations specialize in an innovative and effective treatment process. We understand each patient has a unique set of challenges that almost always require a custom treatment plan. To ensure successful treatment and recovery, each patient works with a team of trained professionals that set up a personalized treatment and recovery plan that addresses each direct and indirect challenge. Through the use of an interdisciplinary team of professionals, our patients and their families can rest assure that they will receive an exceptional level of service and care. OUR MISSION To provide compassionate and highly effective mental health treatment options, utilizing a collaborative team approach to care in the most appropriate setting to meet the diverse behavioral health needs of the communities we serve. We work with all age groups including children, adolescents, adults, and senior citizens. We work with active duty and retired military to help with complex service member related problems as well as more common yet serious illnesses such as PTSD. We works with patients through acute inpatient care, partial day programs, intensive outpatient programs and psychiatric residential treatment options.

overview

Required skills & experience: • At least one year of director level experience with Utilization Review, preferably with a Behavioral Health organization. • Candidate will possess an accredited master’s degree in social work, mental health or be licensed as a Registered Nurse in the state of Texas. • One year’s experience with communication with external review organizations or comparable entities and direct clinical experience in a psychiatric or mental health setting is strongly preferred. • Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. • Ability to communicate professionally and effectively, orally, in person, and in writing, with multidisciplinary team members, managed care organizations and business office, providing needed information in a logical, concise manner using technical language that accurately describes patient’s condition and need for hospitalization. • Ability to organize and prioritize workload to meet deadlines, orchestrate a myriad of activities and to manage multiple priorities within complex and changing systems. • Able to self-regulate and facilitate helpful management dynamics during stressful situations. • Timely renew and maintain an active registered nursing license, cardiopulmonary resuscitation for healthcare professionals certification, professional skills verification and “Handle with Care” (psychiatric crisis management) certification. What you need to know: • Provides oversight and direction to Utilization Review department. • Participates in the recruitment and selection of Utilization Review personnel and ensures sufficient staff are hired. • Participates in budget development for the Utilization Review department. • Audit Utilization Review staff and files to ensure Quality Assurance and meeting JCAHO, CMS, third party payors, managed care organizations and state and federal regulatory standards/requirements. • Assists CEO in preparing staff for inspection survey. • Participates in the preparation of the Plan of Correction response to an inspection survey and implements any follow-up QA required for any Utilization Review allegations • Analyzes patient 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 correctly timely by responsible personnel. • Analyzes insurance, governmental and accrediting agency standards to determine criteria concerning admissions, treatment and length of stay of patients. • Reviews application for patient admission and approves admission or refers case to utilization review committee for review and course of action when case fails to meet admission standards.

benefits