Director of Utilization
About this role
Overview
Come join our team as a Director of Utilization at Sierra Tucson Behavioral Health! A place of hope and healing for individuals and families whose lives have been disrupted by medical and behavioral health challenges. Sierra Tucson is a place of peace, hope, and healing.
On our serene, 160-acre campus, experienced professionals provide integrative, evidence-based care to help adults of all genders achieve lasting recovery from addiction and mental illness. Located in the foothills of the beautiful Santa Catalina Mountains near Tucson, Arizona, the 160-acre campus offers a natural healing environment with the highest level of confidentiality, serenity, and individual respect. The secluded setting is ideal for an atmosphere of tranquility as well as safety.
PURPOSE STATEMENT:
Direct and manage the day-to-day operations of the Utilization Review department.
Responsibilities
ESSENTIAL FUNCTIONS:
- Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
- Conducts and oversees concurrent and retrospective reviews for all patients.
- Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
- Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
- Collaborates with ancillary services in order to prevent delays in services.
- Evaluates the UM program for compliance with regulations, policies and procedures.
- May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
- Six or more year's clinical experience with the population of the facility preferred.
- Four or more years’ experience in utilization management required.
- Three or more years of supervisory experience required.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
AHCORP
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