Corporate Director of Utilization Review

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 company matching 401K, 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.

Job Summary

The Corporate Director is responsible to ensure effective and cost-efficient management of Utilization Review & Management (“UR/UM”). The Corporate Director of UR/UM, in conjunction with facility leadership and their UR teams, will oversee operations to ensure our patients: 1) receive appropriate access to our facilities, 2) are provided the right level of care at the right time, and 3) maximize access, care, and revenue potential for the business in a highly ethical work environment.  We firmly believe that good UR is great service and care. He/she facilitates crucial coordination with Call Center, facility admissions, billing, denial management, collections and related support activities across the AAC enterprise. This individual is responsible for the development and maintenance of policies, procedures, processes, systems, metrics, people and programs required to improve the quality and performance of our end-to-end UR/UM, and in coordination with the AAC Revenue Cycle processes.

Duties and Responsibilities:

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.

• Provide strategic direction and leadership to the UR teams in the field.
• Develop, implement and maintains cost-effective UR/UM policies, procedures, systems, processes, metrics and programs to improve intake quality
• Provide scheduled and just-in-time training to the field staff; assist in orienting new staff in the field
• Provide expertise for complex cases; handle escalations for just-in-time needs in the field
• Identify and spread best practices; develop playbooks to socialize across the enterprise
• Develop, motivate and coach employees to their potential; In collaboration with facility CEOs, conduct performance evaluations and disciplinary action as necessary
• Develop and achieve AAC targets for UR performance
• Conduct tracers on UR throughout the admissions through revenue cycle process to identify areas for improvement, gaps in knowledge, or training needs
• Conduct regular site visits as needed with COO to ensure facilities’ UR departments meet performance standards and have implemented best practices
• Collaborate with IT, Finance, Billing and Managed Care leadership to perform necessary review, testing, training and oversight of our UR systems to ensure data integrity resulting from and used within the UR, billing and collections processes
• Partner with IT and Billing to identify automation improvements to streamline workflows, reduce errors, and eliminate unnecessary manual “workarounds”
• Support AAC’s growth through participation in business reviews; provide due diligence as it pertains to UR
• Develop transition plans and oversee the effective and timely integration of UR into newly developed or acquired programs, services or facilities
• Implement a communication program for all involved in UR activities
• Coordinate with managed care contracting and payor relations on UR related elements, challenges and opportunities to improve working relationships and patient care
• Consult and collaborate with Legal when we identify payors not acting with integrity and according to their provider plan or the law
• Maintain customer satisfaction through timely courteous accurate responses to patient, payor and responsible party for any UR inquiries
• Implement appropriate staff education programs and develop training programs to ensure compliance with applicable laws, regulations, payor and requirements applicable to our business
• Ensure departmental compliance with HIPPA regulations

Education/Experience:

• Bachelor’s degree in healthcare or related field; Master’s degree strongly preferred RN strongly preferred and highly desirable
• RN strongly preferred and highly desirable
• Minimum ten years of healthcare UR and/or case management experience; preferably at least five years in a leadership role in UR
• In-depth knowledge of Interquel or similar system (although not used in this role)
• Excellent oral, written, and interpersonal communication skills. Ability to interface with staff and demonstrate leadership with various levels of UR knowledge and skillsets
• Demonstrated leadership skills and experience, able to work cross-functionally, build consensus, and develop staff
• Results-oriented leader; able to develop and manage with KPI and metrics
• Understanding of revenue cycle, ASAM Patient Placement Criteria, and managed care medical necessity criteria
• Sense of urgency related to process improvement, especially PDSA focused
• Knowledge of healthcare EMR, billing systems, and reporting requirements
• Must be proficient in Microsoft Office Suite
• Must have a proven ability to become proficient in the use of Sigmund and Salesforce

Physical Requirements

“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”

• Prolonged sitting at a desk
• Must be able to lift 15 pounds at a time

American Addiction Centers is an equal opportunity employer.  American Addiction Centers prohibits employment practices that discriminate against individuals or groups of employees on the basis of age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.