Director of Utilization
On-siteCenter Point, Texas, United States
Job Summary
Monitor utilization of services and optimize reimbursement while maximizing patient provider benefits. Conduct concurrent and retrospective reviews for all patients and act as a liaison between Medicaid reviewers and staff to facilitate the review process. Collaborate with physicians, therapists, nursing staff, and ancillary services to prevent delays and ensure optimal care based on patient needs. Evaluate the UM program for compliance with regulations and review charts to make recommendations regarding managed care issues. Provide staff management including hiring, development, training, and performance management to ensure effective department operation.
Required Qualifications
- Bachelor's Degree in nursing or other clinical field
- Four or more years' experience in utilization management
- Three or more years of supervisory experience
- 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
Desired Qualifications
- Master's Degree in clinical field
- Six or more year's clinical experience with the population of the facility
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