Director of Utilization (100% onsite)

Location: Center Point, Hill Country, southeast of Kerrville, approximately 30 minutes northwest of Boerne, Texas.

Purpose

Direct and manage the day‑to‑day operations of the Utilization Review department.

Responsibilities

• Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs.
• Conduct and oversee concurrent and retrospective reviews for all patients.
• Act as a liaison between Medicaid reviewers and staff completing required paperwork to facilitate the Utilization Review process.
• Collaborate with physicians, therapists, and nursing staff to provide optimal review based on patient needs.
• Collaborate with ancillary services to prevent delays in services.
• Evaluate the UM program for compliance with regulations, policies, and procedures.
• Review charts and make necessary recommendations to physicians regarding utilization review and specific managed‑care issues.
• Provide staff management—including hiring, development, training, performance management, and communication—to ensure effective and efficient department operation.

Other Functions

• Perform other functions and tasks as assigned.

Requirements

• Bachelor’s Degree in nursing or other clinical field (required).
• Master’s Degree in a clinical field (preferred).
• Six or more years of clinical experience with the facility’s population (preferred).
• Four or more years of experience in utilization management (required).
• Three or more years of supervisory experience (required).

Licenses/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.