Director of Utilization

About the Role

Seven Hills is a behavioral health hospital serving juveniles, adolescents, adults, and geriatric patients in Las Vegas, Nevada. We are seeking a Director of Utilization who is passionate about helping others and thrives in a dynamic, collaborative environment.

This role directs and manages 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 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 of experience in utilization management required.
• Three or more years of supervisory experience required.
• 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.