What are the responsibilities and job description for the Director of Utilization Review position at Oceans Healthcare?
Benefits We Offer:
Medical, Dental, Vision Coverage (Multiple Plan Options) - Eligible first of the month after 30 days.
401 (k) Retirement Savings Plan with Discretionary Company Match
Tuition Reimbursement
Daily Pay
Paid Time Off
Competitive Market Compensation
Short Term Disability, Long Term Disability
Life Insurance
Employee Assistance Program
Rn Degree Required
The Director of Utilization Review is responsible for management of all utilization review/case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs. The Director of Utilization Review, along with the Clinical Director, oversees the UR Coordinators in the department and is there to help when asked. Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning. Coordinates information between third party payers and medical/clinical staff members. Interacts with members of the medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered. All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and Performance Improvement Standards
Requirements
Educational / Experience Requirements:
Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred. At least two years psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
Qualifications / Skills:
Must have excellent assertive communication skills and leadership skills. Knowledge and in-depth understanding of CD/psych treatment and discharge planning process. Must have good writing and composition skills. Must have good understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care. Must demonstrate strong patient advocacy skills. Must be able to organize and prioritize high volume workload. Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner. Must be able to function with minimal supervision. Therapeutic Intervention De-escalation Education required. Must have ability to maintain overall good work attitude and interact cooperatively and professionally with other staff members and third party payers to achieve mutually beneficial outcome. Must possess basic competency in age/disability/cultural diversity needs of patients served and ability to relate to patients in a manner sensitive to those needs. Must successfully complete CPR certification and an Oceans approved behavioral health de-escalation program.
Work Environment:
Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful; must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.
Medical, Dental, Vision Coverage (Multiple Plan Options) - Eligible first of the month after 30 days.
401 (k) Retirement Savings Plan with Discretionary Company Match
Tuition Reimbursement
Daily Pay
Paid Time Off
Competitive Market Compensation
Short Term Disability, Long Term Disability
Life Insurance
Employee Assistance Program
Rn Degree Required
The Director of Utilization Review is responsible for management of all utilization review/case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs. The Director of Utilization Review, along with the Clinical Director, oversees the UR Coordinators in the department and is there to help when asked. Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning. Coordinates information between third party payers and medical/clinical staff members. Interacts with members of the medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered. All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and Performance Improvement Standards
Requirements
Educational / Experience Requirements:
Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred. At least two years psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
Qualifications / Skills:
Must have excellent assertive communication skills and leadership skills. Knowledge and in-depth understanding of CD/psych treatment and discharge planning process. Must have good writing and composition skills. Must have good understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care. Must demonstrate strong patient advocacy skills. Must be able to organize and prioritize high volume workload. Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner. Must be able to function with minimal supervision. Therapeutic Intervention De-escalation Education required. Must have ability to maintain overall good work attitude and interact cooperatively and professionally with other staff members and third party payers to achieve mutually beneficial outcome. Must possess basic competency in age/disability/cultural diversity needs of patients served and ability to relate to patients in a manner sensitive to those needs. Must successfully complete CPR certification and an Oceans approved behavioral health de-escalation program.
Work Environment:
Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful; must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.
