Director of Utilization Review
Aurora San Diego, United States

As Director of Utilization Review, you will be responsible for monitoring and optimizing reimbursement of services for the organization.

Responsibilities:

• Carries out the personnel management activities associated with direct staff supervision, including screening and selection, orientation training and development, performance management, and employee relations functions
• Conducts admission reviews
• Conducts concurrent and extended stay reviews
• Serves as the department's fiscal manager
• Prepares and submits appeals to third party payors
• Maintains appropriate records of the Utilization Review Department
• Participates in activities, which enhance professional growth and development
• Demonstrates conduct in keeping with the company’s ethical standards
• Complies with facility safety, infection control, and security program
• Supports facility internal and external customer service standards

Requirements

• Familiarity with medical terminology, diagnostic terms, and treatment modalities; knowledge of medical record-keeping
• knowledge of managed care environment
• Ability to apply and interpret admission and continued stay criteria, understanding of admission and discharge function
• Strong interpersonal, organizational, evaluative, and time management skills; policy interpretation skills
• Ability to comprehend psychiatric evaluations, consults, lab results, etc.

Qualifications:

• Clinical degree such as nursing, social work, psychology, health information management or other healthcare related field is preferred
• Bachelor’s degree in relevant field
• Experience in a psychiatric setting preferred
• 2 to 5 years of management experience preferred

Benefits

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
• Short and Long-Term Disability (with additional buy-in opportunities)
• Tuition Reimbursement

Job Rewards and Benefits