• Director of Utilization Review Management

    Job ID
    2019-2618
    # of Openings
    1
    Job Locations
    US-MS-Etta
    Posted Date
    1 month ago(1/13/2020 4:25 PM)
    Category
    Utilization Review (UR)
  • Overview

    Company Summary

    If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include employee stock purchase program, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

     

    Reports to:       Facility CEO

    FLSA Status:     Exempt

     

    Job Summary

    The Director of Utilization Review Management is responsible for the direct supervision, education, mentoring and enhancement of UR Team performance and day-to-day operations of the Utilization Management Departments. The Director will contribute to AAC’s success by ensuring appropriate competency of staff, appropriate authorizations and length of stay management based medical necessity criteria, evidence-based medicine and collaboration with internal teams and will ensure effective management of medical necessity denials

     

    Responsibilities

    Job Knowledge/Skills:

    • Serve as the Director for designated AAC location.

    • Work closely with Administration team leaders and Vice President of Utilization Management

    • Develops programs to promote integration of addiction, behavioral health and medical services which support continuity and coordination among payors

    • Overall responsibility for implementation of the Utilization Management programs

    • Monitors substance abuse utilization authorization and claims data

    • Assures that policies adhere to contractual obligations

    • Develop targeted education and training for and provide clinical guidance to the UR Coordinators

    • Provides direct supervision and mentorship to UR team

    • Completes quality audits on staff and monitors and improves productivity

    • Consultation with practitioners and clinical SME’s to create process improvements

    • Participation in clinical workgroups as required

    • Participation in committees as required

    • Negotiates Single Case Agreements with out of network providers when indicated.

    • Develops new policies and procedures when indicated.

    • Builds on the organizations mission.

    Qualifications

    Education, Experience, Skills & Ablilities:

    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, Behavioral Health or Social Work Field
    • Unrestricted license
    • Five (5) years of experience in direct Utilization/Case Management leadership and;
    • Substance abuse experience preferred and strongly considered.
    • Expert in ASAM criteria required
    • Expert written and verbal communication skills. Demonstrates active listening skills; communicates clearly and concisely; write clearly and informatively; edits work for spelling and grammar.
    • Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills;
    • Expert knowledge of Microsoft Word, Excel, and Outlook.
    • Expert knowledge of health insurance, managed care organizations, and third party payers.
    • Strong clinical skills
    • Expert knowledge of behavioral health resource management and ensures appropriate and necessary utilization of company resources
    • Ability to prepare appeals for denials and experience with appeals at all levels of care required
    • Expert interaction 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.
    • Continually proactive.
    • Strong negotiation skills and experience with single case agreement negations required.
    • Patient/institution/staff advocacy skills.
    • Ability to maintain composure and dignity in all interactions and circumstances.
    • Ability to work in a fast-paced, demanding environment with constant interruptions, and multitask.
    • If in personal recovery, a minimum of 3 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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