Director of Utilization

Job description

Overview ​ Seven Hills is a behavioral health hospital serving juveniles, adolescents, adults and geriatric patients. Seven Hills Behavioral Health is located in beautiful, Las Vegas, Nevada. We are seeking a Director of Utilization. We are seeking an individual who is passionate about helping others, while working in a dynamic and collaborative environment. PURPOSE STATEMENT: ​Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities: ​ ESSENTIAL FUNCTIONS: - ​Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs. - ​Conducts and oversees 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. - ​Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs. - ​Collaborates with ancillary services in order to prevent delays in services. - ​Evaluates the UM program for compliance with regulations, policies and procedures. - ​May review charts and make necessary recommenda...