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Director-Utilization Management

Company: Camp Recovery
Location: San Jose
Posted on: November 22, 2021

Job Description:

ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs. * Conducts and oversees concurrent and retrospective reviews for all patients. * Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process. * Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs. * Collaborates with ancillary services in order to prevent delays in services. * Evaluates the UM program for compliance with regulations, policies and procedures. * May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues. * Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: * Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred. * Six or more year's clinical experience with the population of the facility preferred. * Four or more years' experience in utilization management required. * Three or more years of supervisory experience required. LICENSES/DESIGNATIONS/CERTIFICATIONS: * If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

Keywords: Camp Recovery, San Jose , Director-Utilization Management, Executive , San Jose, California

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