Director of Utilization Review
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Job Location:
Raleigh, WV - USA
Monthly Salary:
Not Disclosed
Posted on:
11 hours ago
Vacancies:
1 Vacancy
Job Summary
Your experience matters:
Triangle Springs is a behavioral health hospital located in Raleigh NC. We provide inpatient and outpatient programming for those facing mental health and addiction challenges. Our programs offer caring compassionate treatment for adults (18) and include inpatient mental health and addiction treatment and detox Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).
How youll contribute
The responsibility of the Utilization Review Director is to ensure the utilization review activities are completed accurately and in a timely manner. This includes the precertification and recertification peer to peer process and appeals. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals. The Director will ensure that all UR staff members follow department and facility procedures. The Director will further ensure that communication with all relevant departments but especially CBO and Business Office meets staff and patient needs. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals.
Responsibilities:
- Oversees the UR department ensuring staff has completed all assignments and monitors performance.
- Ensures all pre-certifications are completed for inpatient and outpatient services.
- Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.
- Assists with creation of treatment team agenda and participates to ensure team is aware of coverage info as well as collecting information for communication with insurance or other funding source.
- Be available to educate staff members from other relevant departments on documentation requirements / medical criteria and does so in a professional organized and understandable manner.
- Works with DON to ensure documentation requirements are met.
- Ensure appeals are completed thoroughly and on a timely basis.
- Interface with managed care organizations external reviews and other payers.
- Participates in Administrator on Call rotation.
- Communicate with physicians to schedule peer reviews.
- Accurately report denials.
What we offer
Fundamental to providing great care is supporting and rewarding our addition to your base compensation this position also offers:
- Comprehensive medical dental and vision plans plus flexible-spending and health- savings accounts
- Competitive paid time off and extended illness bank package for full-time employees
- Income-protection programs such as life accident critical-injury insurance short- and long-term disability and identity theft coverage
- Tuition reimbursement loan assistance and 401(k) matching
- Employee assistance program including mental physical and financial wellness
- Professional development and growth opportunities
Qualifications and Requirements
Applicants should possess the following qualifications and skills:
- Education: Bachelors degree required. Masters degree preferred.
- Experience:Previous utilization review experience in a psychiatric healthcare facility preferred.
- License: Current unencumbered clinical license strongly preferred.
- Additional Requirements:CPI and CPR preferred within 30 days of hire. May be required to work flexible hours.
- Triangle Springs strives to maximize the health function and quality of life of those we serve through comprehensive physical medicine and rehabilitation programs. We are accredited by The Joint Commission and CARF-accredited for our Comprehensive Integrated Inpatient Rehabilitation Program and our Stroke and Brain Injury Specialty programs.
EEOC Statement
Required Experience:
Director
Key Skills
- Crisis Management
- Marketing
- Public Relations
- Fundraising
- Media Relations
- Constant Contact
- Strategic Planning
- Social Media Management
- Team Management
- Public Speaking
- Wordpress
- Writing Skills
About Company
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 a ... View more
