What are the responsibilities and job description for the Director, Utilization Management position at Rebound Behavioral Health?
The Director of Utilization Management at Rebound Behavioral Health will direct, manage and oversee the operations of the Utilization department including working with internal departments such as Business Office and Chief Financial Officer, as well as external partners including insurance companies.
Rebound Behavioral health is located in Lancaster, SC and serves both the South Carolina and North Carolina communities. At Rebound Behavioral Health we serve patients over the age of 18 who are currently experiencing a behavioral/mental health crisis, as well as seeking substance abuse treatment. We are just 45 minutes outside of Charlotte, NC and 90 minutes outside of Columbia, SC situated on 30 acres of beautiful property.
Functions include but not limited to:
- 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.
Education/Experience/Skill/License 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.
- CPR and de-escalation certification required (both provided on-site).
Job Type: Full-time
Pay: $63,000.00 - $75,000.00 per year
Experience:
- Utilization review: 1 year (Preferred)
- Insurance verification: 1 year (Preferred)
Work Location: In person
Salary : $63,000 - $75,000
