Corporate Director of Admissions and Payor Relations

Join a team where your work truly makes a difference. For nearly 70 years, Caron Treatment Centers has helped individuals and families find hope, healing, and lasting recovery through compassionate, evidence-based addiction and behavioral healthcare. At Caron, employees are supported with opportunities to learn, grow, and build meaningful careers, along with competitive pay, comprehensive benefits, generous paid time off, tuition reimbursement, and a 401(k) plan. 

We’re proud to foster a supportive, collaborative workplace where employees feel valued and connected to our mission. That commitment has earned Caron multiple national and regional Top Workplace recognitions, including being named a USA TODAY Top Workplace for 2026. 

Join us to build a career with purpose, growth, and impact at Caron.

Corp Director of Admissions and Payor Relations DUTIES AND RESPONSIBILITIES:

Leadership and Operations

• Directs, supervises, trains, and develops admissions call center, intake, verification of benefits (VOB), utilization review (UR), and financial clearance staff across all programs and levels of care, ensuring adequate staffing, scheduling, and coverage seven days per week, including evenings, weekends, and holidays as applicable.
• Establishes departmental goals, performance metrics, and service standards aligned with organizational objectives and develops and implements admissions policies and procedures consistent with state regulations, CARF standards and best practices.
• Monitors and improves admissions workflows and analyzes trends to improve efficiency, accuracy, call conversion, census growth, and positive client experience.

Call Center Operations and Oversight

• Directs day-to-day admissions call center operations, including inbound and outbound call handling, call routing, queue management, callbacks, after-hours coverage, and digital inquiry channels such as Live Chat and online forms.
• Establishes and monitors call center key performance indicators (KPI’s), including service level, average speed of answer, abandonment rate, average handle time, first-call resolution, and inquiry-to-admission conversion, applying workforce management principles and real-time and historical data to forecast volume and adjust staffing.
• Oversees call center technology, including ACD/telephony, IVR, call recording, call tracking, and Salesforce CRM, partnering with IT to optimize system performance and reporting.
• Implements a call center quality assurance program including call monitoring, scorecards, side-by-side coaching, and calibration and develops call scripts, call flows, and training that integrates motivational interviewing, crisis and escalation protocols, and HIPAA and 42 CFR Part 2 privacy requirements.

Admissions and Intake Management

• Oversees the intake process from initial inquiry through admission and program placement, including bed management and tier scheduling, ensuring prompt response to all referrals, inquiries, and requests for services.
• Facilitates screening and assessment to determine eligibility and level of care, collaborating with clinical leadership to ensure placements align with ASAM criteria, clinical recommendations, and organizational capabilities.
• Ensures accurate admissions documentation within the electronic health record and related systems, and coordinates and facilitates communication between all departments to provide accurate admissions information.
• Addresses complex admissions cases, barriers to placement, and escalated concerns.

Verification of Benefits and Financial Clearance

• Serves as the department’s subject matter expert in verification of benefits, providing oversight, training, and final review of insurance verifications for commercial, managed care, Medicare, Medicaid, EAP, and self-pay populations.
• Ensures complete and accurate VOBs are performed prior to admission, including eligibility, plan type, network status, in- and out-of-network benefits, deductibles, co-insurance, out-of-pocket maximums, behavioral health carve-outs, coordination of benefits, plan exclusions, and coverage by level of care (withdrawal management, residential, PHP, IOP, and outpatient), and ensures financial responsibility is clearly communicated to patients, families, and referents.
• Oversees the financial clearance process to ensure every admission is verified, authorized, and financially cleared, including patient responsibility estimates, deposits, payment arrangements, single case agreements, financial assistance eligibility, and compliance with Good Faith Estimate requirements under the No Surprises Act.
• Develops and maintains VOB and financial clearance policies, workflows, and quality audits to minimize denials, write-offs, and accounts receivable risk, and maintains current knowledge of payer policies, contract terms, and network status as the liaison with payer representatives and the revenue cycle team.

Utilization Review

• Provides oversight of the utilization review function, ensuring timely pre-certification, concurrent review, and discharge review with all payers, and monitoring authorization status and approved days to prevent lapses in coverage and unauthorized days.
• Ensures clinical information submitted for authorization supports medical necessity in accordance with ASAM Criteria and payer-specific criteria and educates clinical teams on documentation requirements that support continued stay.
• Oversees denial management and appeals, including peer-to-peer reviews, expedited appeals, and retrospective reviews, in collaboration with clinical and medical leadership.
• Tracks and analyzes UR metrics, including authorization approval rates, average authorized length of stay, denial rates by payer and reason, and appeal overturn rates, and implements process improvements to reduce denials.
• Ensures all payer communications follow HIPAA and 42 CFR Part 2 consent and minimum necessary requirements.

Business Development and Referral Management

• Collaborates with marketing and business development staff to increase community awareness and referral opportunities, monitoring referral activity to identify opportunities for service expansion and community partnership development.

Financial and Performance Management

• Monitors admissions performance metrics including inquiry volume, call center service levels, conversion rates, referral source activity, admission timelines, VOB accuracy, authorization and denial rated, occupancy levels, and census trends and prepares and presents departmental reports to executive leadership. Utilize data to measure staff competencies and effective staffing patterns.
• Monitors financial planning and allocation of financial aid to meet census and budgetary goals, including yearly restricted funding and ensures the financial assistance application process complies with corporate financial award policy. 
• Collaborates with revenue cycle and clinical teams to ensure accurate payer data, clean claims, and alignment between verification, authorization, and billing to protect revenue integrity.
• Supports budget development and responsible management of departmental resources.

This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the duties or tasks that may be required or assigned.

PHYSICAL REQUIREMENTS:

The physical and mental demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Ability to communicate effectively in person, by phone and electronically.
• Ability to sit, stand, walk, and utilize office equipment for extended periods of time.
• Able to ambulate on Caron’s campuses to facilitate tours.
• Able to travel between organizational locations as required
• Available to participate in On Call rotation when needed.

EDUCATION /EXPERIENCE QUALIFICATIONS:

• Bachelor’s degree in healthcare administration, business administration, behavioral health, social work, psychology, counseling, or related field is required. Master's degree is preferred.
• 5years’ experience in chemical dependency field with a working knowledge of addiction is required
• 5 years’ experience in a healthcare call center, patient access, intake, or admissions environment is required, including direct oversight of call center operations, staffing, and performance metrics.
• 3 years’ hands-on experience performing and overseeing verification of benefits, pre-authorization, and financial clearance, preferably for behavioral health or SUD services, is required.
• 3 years’ experience in utilization review or utilization management, including concurrent review, denial management, and appeals, is required.
• Experience with call center technology (ACD/telephony, IVR, call recording, workforce management) and CRM platforms is required.
• 5 years of progressive leadership experience is required.
• Minimum of three years of supervisory or management experience is required.
• Licensed behavioral health professional (LPC, LCSW, LMFT, CAADC, CADC, or equivalent) is preferred.
• Familiarity with CARF accreditation standards and state licensure is required.
• Experience with nonprofit healthcare or substance use disorder treatment is preferred.
• Experience leading multi-site admissions operations is preferred.
• Certified Healthcare Access Manager (CHAM) or utilization review certification is preferred.
• CAAP certification within 2 years of hire.

KNOWLEDGE, SKILLS AND ABILITIES:

• Demonstrated leadership, coaching and team development skills
• Excellent interpersonal, communication and customer service abilities. Proven customer service excellence.
• Strong problem solving, organizational, and decision-making skills.
• Expert knowledge of verification of benefits, benefit interpretation, coordination of benefits, network status, and patient financial responsibility for behavioral health and SUD services.
• Expert knowledge of utilization review and utilization management, medical necessity criteria, payer authorization requirements, and denial and appeal processes.
• Advanced knowledge of call center operations, workforce management, service level metrics, and quality assurance practices.
• Knowledge of payer types and requirements, including commercial, managed care, Medicare, Medicaid, and the No Surprises Act.
• Ability to analyze operational and financial data and develop actionable solutions. A strategic thinker.
• Ability to demonstrate financial sophistication through following financial policies and procedures
• Knowledge of ASAM Criteria, levels of care, SUD treatment services, and behavioral healthcare systems.
• Knowledge of HIPAA, 42 CFR Part 2, and applicable behavioral healthcare regulations.
• Proficiency with electronic health records, Salesforce, payer portals and eligibility tools, call center reporting systems, and Microsoft Office applications
• If in recovery, 2 years of continuous sobriety is preferred.