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Director of Utilization Management

Director of Utilization Management

Acadia HealthcareMurfreesboro, TN, US
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Director Of Utilization Management

TrustPoint Hospital is looking for an experienced Director Of Utilization Management to join our team! This position will lead all daily operations of our Utilization Review team.

TrustPoint Hospital is a 217-bed, state-of-the-art treatment center providing comprehensive medical and psychiatric services on both inpatient and outpatient bases. We deliver exceptional care to patients needing acute physical medicine and rehabilitation, adult, adolescent, geriatric psychiatry, and medical psychiatry.

TrustPoint Hospital offers an extensive array of benefits to our valued team members.

  • Medical, Dental, and Vision Insurance coverage
  • Health Savings Account (HSA) and Flexible Spending Account (FSA) options
  • Company-paid Basic Life & AD&D insurance
  • Disability benefits
  • 401(k) Retirement Plan with a company match
  • Employee Assistance Program (EAP) and Employee Discount Program
  • Paid Holidays for work-life balance
  • Paid Time Off (PTO)
  • Tuition Reimbursement opportunities for career advancement

Direct and manage the day-to-day operations of the Utilization Review department.

  • Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's 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.
  • Collaborate with physicians, therapist, and nursing staff to provide optimal review based on patient needs.
  • Collaborate with ancillary services in order to prevent delays in services.
  • Evaluate 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 including hiring, development, training, performance management, and communication to ensure effective and efficient department operation.
  • Perform other functions and tasks as assigned.

    Bachelor's Degree in nursing or other clinical field required. Master's 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 required. Three or more years of supervisory experience required.

    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 required, within the state where the facility provides services.

    We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal, and local laws.

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    Director Utilization Management • Murfreesboro, TN, US