• Director of Clinical Utilization Management

    Job ID
    2018-1814
    # of Openings
    1
    Job Locations
    US-NV-Las Vegas
    Posted Date
    3 weeks ago(3 weeks ago)
    Category
    Utilization Review (UR)
  • Overview

    Job Summary:    SOLUTIONS RECOVERY

     

    The Director of Clinical Utilization Review is responsible for the supervision and day to day operations of the Utilization Management Department to contribute to AAC’s success by extending length of stays with approvals for financial reimbursement, by performing the following duties.

     

    Reports To: Vice President of Clinical Operations

    Responsibilities

    Job Duties:

    • Maintains a partial caseload and provides coverage for staff absences
    • Oversees assignment of cases
    • Provides daily consultation and supervision as needed
    • Hires, Orients and Trains new staff
    • Approves PTO and leave requests
    • Completes 90-day and Annual Evaluations
    • Develops and maintains a system of appeals peer review, post service claims and reconsiderations including internal and external review escalation
    • Monitors, reports and recommends changes based on UR dashboard information
    • Conducts monthly UR meetings to discuss department and system issues
    • Work with UR to develop consistency and provide for adoption of best practices
    • Participate in Corporate UM activities
    • Monitors adherence to company, corporate and department policies and procedures
    • Create and support a positive, professional and team oriented environment
    • Other duties as assigned
    • Responsible and accountable for managing direct reports
    • Preparation and presentation of performance evaluations
    • Provides objective feedback to employees
    • Makes appropriate compensation recommendations, if applicable
    • Provides appropriate training  for department and hold staff accountable for attending required training
    • Holds interviews for vacant positions and makes appropriately selects candidates to fill open positions
    • Responsible for recommending and ensuring regulatory staffing patterns & managing annual budget
    • Monitors adherence to company and department policies, procedures and practices
    • Creates and supports a positive, professional, team-oriented, harassment free work environment by understanding and complying with the company’s policies

    Qualifications

    Job Requirements:

    • Master’s degree in Behavioral Health or related field.
    • Five (5) years’ experience in direct utilization management services and;
    • Two (2) years’ experience in supervision of utilization management services.
    • Ability to read and interpret written information; write clearly and informatively; edits work for spelling and grammar. Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.
    • Good working knowledge of Microsoft Word, Excel, and Outlook.
    • Familiarity with health insurance, managed care organizations, third party payers, and level of care criteria.
    • Strong clinical skills
    • Knowledge of behavioral health resource management
    • Ability to prepare clinical reviews for managed care companies
    • Ability to ensure appropriate and necessary utilization of company resources
    • Ability to interact with healthcare professionals in all inpatient disciplines to assemble a clear, concise understanding of the patient's healthcare needs.
    • Ability to develop positive working relationships with managed care organizations.
    • Excellent customer service skills.
    • Ability to be continually proactive.
    • Strong negotiation skills.
    • Patient/institution advocacy skills.
    • Ability to maintain composure and dignity in all interactions and circumstances.
    • Strong attention to detail.
    • Strong communication skills.
    • Ability to work in a fast-paced, demanding environment with constant interruptions, and multitask.
    • If in personal recovery, a minimum of 2 years clean and sober.

    AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.

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