Group Director of Utilization Review Position Available In Orange, Florida

Group Director of Utilization Review Pasadena Villa Network Orlando, FL Job Details Full-time Estimated:

$52.9K – $66.7K a year 7 hours ago Benefits Health savings account AD&D insurance Health insurance Dental insurance Flexible spending account Parental leave Employee assistance program Vision insurance 401(k) matching Referral program Qualifications Utilization review 3 years Discharge planning Senior level Behavioral health

Full Job Description Who We Are:

Founded in 2001, Pasadena Villa has treated mental health conditions for all genders ages 18 and older, along with specialty residential programs for autistic clients. Our customized and compassionate care is provided in a therapeutic environment that promotes well-being, recovery, and personal motivation. There are multiple levels of care available at each of our Pasadena Villa locations, each providing the highest levels of care and support and the closest amount of supervision needed.

What We Offer:

Collaborative environment dedicated to clinical excellence Multiple Career Development Pathways Company Supported Continuing Education & Certification

PPO & HDHP

Health Plan Options Flexible Dental & Vision Plan Options 100% Company Paid EAP Emotional Well-Being Support 100% Company Paid Critical Illness (with health enrollment plan) 100% Company Paid Life & ADD 401K with Company Match Company-Sponsored

HSA, FSA, & DSA

Tax Savings Accounts Generous Team Member Referral Program Parental Leave How You Will Contribute:

The Group Director of Utilization Review is responsible for the overall management of the Utilization Review department by leading and facilitating review of assigned admissions, continued stays, utilization practices, and discharge planning according to approved clinically valid criteria. Relationships and Contacts Within the organization : Maintains frequent and close working relationships with the Network Leaders, Business Development team members, Admissions team members, Nursing leadership, milieu leadership, and all clinical team members. Outside the organization : Initiates and maintains strong professional relationships with payor contacts.

Essential Responsibilities:

Responsible for management, guidance, training, and leadership of Utilization Review staff and assist with difficult cases. Medical records review and ongoing training with all clinical/medical staff. Perform regular audits of Utilization Review staff’s work to ensure quality and performance. Maintains current knowledge of Utilization Review process, including denials and concurrent reviews. Revises processes as needed to meet organizational goals. Utilize effective documentation standards that support a strong historical record of actions taken on each account. Maintains a strict level of confidentiality for all company, departmental, and healthcare provider information. Reports challenges/roadblocks to management for resolution.

What We Are Seeking:

Five years’ experience with external review organizations or comparable entities doing pre-certification and concurrent reviews in mental health, substance abuse, and eating disorder facilities. Three years’ experience in the behavioral health field. Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using established facility criteria. Knowledge of medical and behavioral health terminology, and techniques used to diagnose and treat various medical conditions, including practices, standards of care, symptoms, treatment alternatives, medications used for treatment, and preventative healthcare measures. Renaissance Health Care Group, LLC d/b/a Pasadena Villa provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunity applies to all terms and conditions of employment. Renaissance Health Care Group, LLC d/b/a Pasadena Villa reserves the rights to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains “At-Will.”