Description

Director of Utilization Review responsibilities include:

• Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs

• Work with physicians, social workers and nursing staff to provide optimal review based on patient needs

• May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues

• Work with ancillary services in order to prevent delays in service

• Provide oversight and direction to the utilization review staff

• Responsible for the concurrent and retrospective reviews for all patients

Qualifications

Education

Required

• Bachelors or better in Social Services

Preferred

• Masters or better

Licenses & Certifications

Required

• Reg Nurse

Experience

Required

• 4 years: Utilization Management in a Behavioral Health setting

• 6 years: Clinical Experience in a Behavioral Health setting

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 60-1.35(c)