Director of Utilization

Overview Park Royal Hospital is a private free-standing 126-bed psychiatric hospital that provides life-changing care for adolescents 13-17 years, adults 18 years, and older and senior adults. Inpatient and outpatient treatment are provided for depression, anxiety, mood disorders, memory problems, post-traumatic stress disorder, and other mental illnesses as well as co-occurring substance abuse disorders. ​

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. This position requires a Level 2 Background Screening through the Florida Care Provider Background Screening Clearinghouse. In accordance with Florida law, employers must provide applicants with direct access to information about the state's background screening requirements. To learn more about disqualifying offenses, exemption procedures, and screening timelines, please visit the Agency for Health Care Administration (AHCA) Background Screening Education & Awareness webpage: https://info.flclearinghouse.com/ Applicants are encouraged to review these requirements before applying. 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.