0000 Facility - Director of Utilization

​ PURPOSE STATEMENT: ​ Direct and manage the day-to-day operations of the Utilization Review department . M-F Days $82,000- $88,000 Annually ​

​ 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.

EDUCATION/EXPERIENCE/SKILL

​ 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. ​ F our 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.

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