Director of Utilization (100% onsite)

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

About the Role

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.
• 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 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.
• 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 in the state where the facility provides services.
• Or current clinical professional license or certification as required in the state where the facility provides services.