Director of Utilization

Seven Hills is a behavioral health hospital serving juveniles adolescents adults and geriatric patients. Seven Hills Behavioral Health is located in beautiful Las Vegas Nevada. We are seeking a Director of Utilization. We are seeking an individual who is passionate about helping others while working in a dynamic and collaborative environment.

PURPOSE STATEMENT:

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 patients 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 to including hiring development training performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Bachelors Degree in nursing or other clinical field . Masters Degree in clinical field preferred.
• Six or more years clinical experience with the population of the facility preferred.
• Four or more years experience in utilization management .
• Three or more years of supervisoryexperience .

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• If applicable current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification as within the state where the facility provides services.

We are committed toprovidingequalemploymentopportunitiestoall applicantsforemploymentregardlessofanindividualscharacteristicsprotected byapplicable statefederalandlocallaws.

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