Director of Utilization Position Available In Middlesex, Massachusetts
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Job Description
Overview Acadia Healthcare is a leading provider of behavioral healthcare services across the United States. Acadia operates a growing network of 250 plus behavioral healthcare facilities with approximately 11,100 beds in 39 states and Puerto Rico. With more than 23,000 employees serving approximately 75,000 patients daily, Acadia is the largest stand-alone behavioral health company in the U.S. Acadia Healthcare’s purpose is to Lead Care With Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation. Director of Utilization – Tufts Medicine Behavioral Health Hospital Tufts Medicine, a leading integrated academic health system in Massachusetts, and Acadia Healthcare, the largest standalone provider of behavioral health services in the U.S., have partnered to create the Tufts Medicine Behavioral Health Hospital, a state-of-the-art, 144-bed facility in Malden, Massachusetts. Slated to open in fall 2025, this hospital is designed to address the growing need for high-quality behavioral health services in the region. The Tufts Medicine Behavioral Health Hospital will serve as a center of excellence, offering inpatient and intensive outpatient programs for patients of all ages. Additionally, it will function as a teaching hospital, providing a vital training site for future behavioral health professionals, including students and residents from the Tufts University School of Medicine. This initiative aims to address the regional shortage of behavioral health clinicians while ensuring a continuum of care for patients and their families. The Director of Utilization will 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. AHGROW
