Director of Utilization (100% onsite)

About the Role

Direct and manage the day-to-day operations of the Utilization Review department at Starlite Recovery Center, a facility with over 67 years of experience treating individuals with Substance Use Disorder. The center is located in the Hill Country, southeast of Kerrville, and approximately 30 minutes northwest of Boerne, Texas.

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 the 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 Utilization Management (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.
• Perform other functions and tasks as assigned.

Requirements

• Bachelor's Degree in nursing or other clinical field required.
• Master's Degree in clinical field preferred.
• Six or more years of 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.

Qualifications

• 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.