Director of Utilization Position Available In St. John the Baptist, Louisiana
Tallo's Job Summary: The Director of Utilization position at Acadia Healthcare-River Place Behavioral Health, affiliated with Ochsner Health System, involves managing the day-to-day operations of the Utilization Review department. Responsibilities include monitoring service utilization, optimizing reimbursement, and collaborating with healthcare professionals. Qualifications include a Bachelor's Degree in nursing or a clinical field, six years of clinical experience, and four years in utilization management. LPN or RN licensure is required. AHMKT -RPBH.
Job Description
Overview Acadia Healthcare-River Place Behavioral Health, an affiliate of Ochsner Health System, provides state-of-the-art psychiatric care for adults who are struggling with depression, anxiety, bipolar disorder, and other mental health concerns.
PURPOSE STATEMENT
Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities
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.
OTHER FUNCTIONS
Perform other functions and tasks as assigned. Qualifications
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. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws. AHMKT #LI-RPBH
