Director of Utilization Review

POSITION TITLE: Utilization Review Director

REPORTS TO (TITLE): Chief Financial Officer (CFO)

EMPLOYEE PAY STATUS: Exempt

DESCRIPTION OF POSITION:

UR Director conducts a review of patients’ statistical information related to utilization review, collects data that profiles that appropriateness and quality of patient care and is a resource to the medical staff with regard to case management.

KEY RESPONSIBILITIES:

· Ensures timely pre-certification an re-certification of patients medical necessity with review organizations and third party payers.

· Provides immediate notification of denial of certification to business office/administration and attending physicians.

· Protects the confidentiality of the patients record and the hospitals liability when releasing information to third party payers and review organizations.

· Maintains a good rapport and a cooperative working relationship with physicians, departments and staff.

Minimum Requirements:

Education and Licensing:

· Bachelor’s degree in related healthcare field required or relevant experience.

· Master’s degree preferred.

Knowledge and Experience:

· Three to five years experience in utilization review or related field, preferred.

· Proficient knowledge of and success in dealing with acute and managed care environment in the mental health field.

· Ability to prioritize and work with minimal supervision.

· Highly organized with detail and results orientation.

· Excellent communication skills, both written and verbal.

· Ability to deal with all levels of stress and handle crises situations.

Skills and Abilities:

· Maintains confidentiality of patients at all times.

· Ability to cope well with stress and have a strong sense of compassion.

· Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.

· Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).

· Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.

· Strong written and verbal communication skills.

· Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.

· Ability to work independently and as part of a team.

· Good judgment, problem-solving and decision-making skills.

· Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.

· Ability to work in a fast-paced, expanding organization.

Physical Requirements:

While performing the duties of this job, this position is frequently required to do the following:

· Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.

· Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.

· Give and follow verbal and written instructions with attention to detail and accuracy.

· Perform complex mental functions and basic arithmetic functions; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data and information.

· Vision: See details of objects at close range.

· Coordinate multiple tasks simultaneously.

· Reach forward, up, down, and to the side.

· Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.

· Lift up to twenty five (25) pounds.

Job Type: Full-time

Pay: $42.81 - $59.94 per hour

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Work Location: In person

Salary : $43 - $60