Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Utilization Management Specialist
Working onsite at our Cambridge City, IN treatment facility
We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth.
Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 30,000 patients daily.
Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works.
Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment.
As a Utilization Management Specialist II, you will need to exhibit excellent communication and documentation skills and work closely with insurers, accrediting bodies, and other healthcare providers. Clinical expertise regarding patient level of care needs is provided to other staff in consultation to ensure proper care in the right amount, scope, and duration. This includes providing utilization review and management (including screening, referral, and information) for mental health and substance abuse services, as well as performing the identification, analysis, and resolution of resource utilization outliers consistent with established protocols, policies, and procedures. As a member of the Utilization Management Team, the Utilization Management Specialist II impacts the delivery of care at the system level through direct utilization management, feedback of performance data, training, and supported consultation. This position provides telephone triage support for the Admissions Department and reviews clinical and financial information to determine eligibility for the appropriate level of care for consumers.
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Join our team. Join our mission.
IND2
Pinnacle Treatment Centers is an equal employment opportunity employer and makes employment decisions based on merit and other legitimate business considerations. We want to have the best available persons in every job. Company policy prohibits unlawful discrimination based on race, traits historically associated with race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), parental leave, national origin, gender, gender identity, gender expression, age, ancestry, physical or mental disability, military and veteran status, marital status, sexual orientation, genetic characteristics or information, political affiliation, non-merit based factors or any other consideration made unlawful by applicable federal, state, or local laws. It also prohibits discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.
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