Director of Quality and Utilization Review

Job ID
2022-5967
Job Locations
US-TN-Brentwood
Posted Date
4 weeks ago(4/26/2022 2:51 PM)
Category
Management

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 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.

Responsibilities

Job Summary

The Director of Quality and Utilization Review is responsible for ensuring that treatment services are documented in a clear and concise manner and follow cost-effective UR practices. This position is responsible for leading company-wide documentation performance and quality improvement as well as UR oversight. The Director of Quality and Utilization Review will work to improve qualitative documentation practices, UR processes, auditing systems, and documentation outcomes. This position will examine each facility's documentation and UR practices and is responsible for analyzing clinical teams' data regarding payor feedback from denials, prepayment reviews, and audits. The Director of Quality and Utilization Review is responsible for providing oversight and management regarding payor audits, qualitative content management, insurance payor guidelines, review processes, and medical necessity requirements to support billing. 

 

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

  • Collaborate closely with executive team and National Director of Performance Improvement and Quality Assurance to develop/improve infrastructure needed to support quality improvements
  • Assure UR standards and clinical documentation meet AAC standards per level of care following ASAM guidelines
  • Routinely monitor documentation and quality of content within the EMR
  • Ensure facility quality assurance reports meet required standards by conducting random audits
  • Continue development and maintenance of documentation standards
  • Communicate with facilities payor requests or UR changes
  • Research payor guidelines, resources and bi/yearly changes
  • Monitor facility pre-payment reviews by obtaining quarterly scorecards and interpret results. Compile deficiencies, distribute to QA and Clinical Directors
  • Manage and direct facility quality improvements systems, medical records department, as well as:
    • Clinical Quality
      • Qualitative chart audits
      • Monthly insurance payor guideline updates
      • Monthly scorecards
    • Compliance
      • Pre-payment Review, CAP and Audit compliance
      • Completion of required reports, updates, and changes

Qualifications

Education/Experience:

  • Bachelor’s degree in nursing preferred or certification in healthcare quality management required
  • Required 2-years minimum experience in UR management within the substance abuse or behavioral healthcare industry.
  • Current knowledge of state and federal regulations, UR processes, payor guidelines, and billing practices for SUD treatment.
  • Experience working with payor prepayment reviews, audits, and reimbursement denials for behavioral healthcare facilities.
  • Strong organizational and leadership skills.

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

Certificates and Licenses:

  • Certified Professional in Healthcare Quality (CPHQ) required

Other Work Requirements:

  • Must have excellent communication skills (written and verbal), interpersonal skills, project management and organizational skills
  • Proficient MS Word, Excel, Outlook, and PowerPoint
  • Working knowledge of Lean Six Sigma/Lean
  • Population health management and/or clinical quality program development experience preferred
  • Experience with Quality Improvement and Corrective Action plans
  • Experience working with private health insurance payors
  • Strong strategic thinking and analytical skills; excellent organizational, presentation, and problem solving skills
  • Candidate must be task and project-oriented with an excellent sense of priority, logic and objectivity.
  • Minimal travel up to 20%

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.

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