Utilization Review Director
Position Summary
A Utilization Review (UR) Director at Freedom Behavioral Hospital is responsible for overseeing utilization review and discharge planning processes in compliance with CMS, federal, and state regulations, as well as the organization’s mission, policies, procedures, and performance improvement standards. In this role, the UR Director works closely with admissions, medical providers, and clinical staff to ensure patients receive appropriate, medically necessary care throughout their stay. They review patient records to evaluate the medical necessity of admissions, treatment plans, and length of stay while ensuring compliance with insurance and government reimbursement requirements. The UR Director manages utilization review activities, including precertification and continued stay authorizations, and serves as the primary point of contact for payor sources. They communicate admission and continued stay criteria with referral sources, families, insurance representatives, and the interdisciplinary treatment team to maintain effective coordination of care. Cases requiring additional clinical expertise are referred to the Medical Director for further review. As a key member of the multidisciplinary team, the UR Director helps facilitate treatment team processes, supports discharge planning efforts, and promotes effective communication among departments. They also maintain performance improvement initiatives within the department and participate in quality management activities to support regulatory compliance and patient care excellence.
Preferred Knowledge, Skills And/Or Expierence
- Education: A degree in a social science is preferred or nursing education
- License Experience: 1+ years coordinating utilization review and discharge planning activities
Benefits
- Challenging and rewarding work environment
- Excellent staff to patient ratio
- Competitive Compensation
- Medical, Dental, Vision, and Prescription Drug Plan
- Generous Paid Time Off
- 401(K) with company match