What are the responsibilities and job description for the Utilization Review Director position at CORNERSTONE OF RECOVERY?
Utilization Review Director
Basic Function : Ensure that patients meet criteria for admission and obtaining third party approvals for access to treatment services
Reports To : Cash Receipts Clerk Company Manager : Chief Clinical Officer
Hours : Full time with fexible hours to meet insurance pre-certification and continuing care approval call requirements
Salary:
Overtime : Not Allowed Evaluations : Annual
Education : College degree or license in chemical dependency counseling or nursing. Experience : Minimum of one yea(s experience in utilization review required.
Management experience is preferred. ·
Responsibilities : 1. Schedule annual review of criteria for admissions, continued stay and discharge wrth CEO, Medical Director and Clinical Directors.
2. Develop and maintain a policies and procedures manual for Utilization Review functions.
3. Develop and annually update a log of utilization criteria of all insurance or managed care companies that are involved in patient care.
4. Train and educate Utilization Review staff
5. Ensure that policies and procedures for Utilization Review activity meets documentation requirements of the business office to facilitate accurate and timely billing.
6. Maintain individual statistics and provide aggregate monthly reports on
Utilization Review functions, including patients treated, levels of care utilized, days of care approved, denials of care and appeal statistics.
7. Provide quarterly statistical reports on Utilization Review activities according to insurance and managed care companies.
8. Provide utilization review certification infonmation in daily clinical business meetings and assist clinicians in care level recommendations.
9. Attend weekly Leadership Meetings
10. Ensure staff are available to meet with patients and families to discuss results of utilization review activity and discuss treatment and attendant costs.
11. Participate in treatment team meetings as needed to discuss treatment
approvals and impact on patient care planning.
12. Assist administration with insurance and managed care contracting.
13. Other duties as may be assigned by the CEO. Skills : 1. Above average verbal and writing skills
2. Ability to educate and train others
3. Above average interpersonal skills and ability to collaborate with key leaders for organizational growth
4. Ability to articulate clinical information and effectively argue for approval
of care
5. Ability to evaluate departmental performance and provide professional reports
6. Ability to negotiate financial contracts
Job Type: Full-time
Pay: $85,000.00 - $95,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $85,000 - $95,000