Utilization Review Director

POSITION TITLE: Utilization Review Director

REPORTS TO (TITLE): Chief Financial Officer

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.

Requirements

Education and Licensing:

• Bachelor’s degree in related healthcare field required. 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.

Benefits

Health Insurance

Vision Insurance

Dental Insurance

401K Retirement Plan

Healthcare Spending Account

Dependent Care Spending Account

Discounted Cafeteria Meal Plan

Life Insurance (Supplemental Life, Term and Universal plans are also available.)

Short and Long-Term Disability (with additional buy-in opportunities)