Top 2 Utilization management reviewer Jobs in Center Point, Tx

Director of Utilization (100% onsite)
Starlite Recovery Center —Center Point, TX
- Full-time
- Nursing
- RN License
- 3 years

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Director of Utilization (100% onsite)

Starlite Recovery Center -
Center Point, TX

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Job Details

Full-time

Qualifications

Staff supervision
Healthcare staff management
Utilization review
Bachelor's degree
Team management
Utilization management
Resource utilization in healthcare

Full Job Description

Overview:

Starlite Recovery Center has an opportunity to hire a Director of Utilization to join their Amazing Team!

Starlite Recovery Center has been treating individuals with Substance Use Disorder for over 67 years. Starlite Recovery Center is located in the Hill Country, southeast of Kerrville, and approximately 30 minutes northwest of Boerne, Texas.

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.

AHGROW

#LI-SLRC

#LI-SK1

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Director of Utilization (100% onsite)

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