Director of Utilization

Job description

Overview We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This role partners closely with clinical leadership and external reviewers to ensure timely reviews, optimize reimbursement, and maintain high standards of care across the facility. ​ 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 ma...