POSITION TITLE: Utilization Review Director
REPORTS TO (TITLE): Chief Financial Officer (CFO)
EMPLOYEE PAY STATUS: Exempt
DESCRIPTION OF POSITION:
UR Director conducts a review of patients’ statistical information related to utilization review, collects data that profiles that appropriateness and quality of patient care and is a resource to the medical staff with regard to case management.
KEY RESPONSIBILITIES:
· Ensures timely pre-certification an re-certification of patients medical necessity with review organizations and third party payers.
· Provides immediate notification of denial of certification to business office/administration and attending physicians.
· Protects the confidentiality of the patients record and the hospitals liability when releasing information to third party payers and review organizations.
· Maintains a good rapport and a cooperative working relationship with physicians, departments and staff.
Minimum Requirements:
Education and Licensing:
· Bachelor’s degree in related healthcare field required or relevant experience.
· Master’s degree preferred.
Knowledge and Experience:
· Three to five years experience in utilization review or related field, preferred.
· Proficient knowledge of and success in dealing with acute and managed care environment in the mental health field.
· Ability to prioritize and work with minimal supervision.
· Highly organized with detail and results orientation.
· Excellent communication skills, both written and verbal.
· Ability to deal with all levels of stress and handle crises situations.
Skills and Abilities:
· Maintains confidentiality of patients at all times.
· Ability to cope well with stress and have a strong sense of compassion.
· Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.
· Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).
· Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
· Strong written and verbal communication skills.
· Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.
· Ability to work independently and as part of a team.
· Good judgment, problem-solving and decision-making skills.
· Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.
· Ability to work in a fast-paced, expanding organization.
Physical Requirements:
While performing the duties of this job, this position is frequently required to do the following:
· Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
· Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
· Give and follow verbal and written instructions with attention to detail and accuracy.
· Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information.
· Vision: See details of objects at close range.
· Coordinate multiple tasks simultaneously.
· Reach forward, up, down, and to the side.
· Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
· Lift up to twenty five (25) pounds.
Job Type: Full-time
Pay: $42.81 - $59.94 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Work Location: In person
