The Director of Utilization Management is responsible for the supervision, education, mentoring and enhancement of UR Team performance and day-to-day operations of the Utilization Management Department. The Director will contribute to AAC’s success by ensuring appropriate authorizations and extending length of stays based on use of medical necessity criteria, evidence-based medicine and collaboration with internal teams.
EDUCATION, EXPERIENCE SKILLS & ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Master’s degree in Nursing or Behavioral Health field
- Unrestricted RN license
- 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.
- Experience with ASAM criteria preferred.
- Familiarity with health insurance, managed care organizations, and third-party payers..
- 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.
Reports To: Facility CEO