Director of Utilization

Utilization Review Manager

Direct and manage the day-to-day operations of the Utilization Review department.

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 recommendations to the physicians, regarding utilization review and specific managed care issues.
• Provide staff management including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

Other Functions :

Education / Experience / Skill Requirements :

Licenses / Designations / Certifications :

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