Director of Utilization Management

Job description

Lead the Utilization Review Department at our 100-bed behavioral health hospital.

Aurora Behavioral Health System is the state's largest psychiatric hospital system, providing high-quality care for adults and adolescents. We emphasize teamwork and a therapeutic environment across inpatient, partial, and outpatient services. We seek an experienced Director of Utilization Management for our Glendale Hospital.

Responsibilities / Job Duties :

• Oversee and manage processes for prior authorization, concurrent review, retrospective review, and appeals, ensuring compliance with hospital standards and regulatory requirements.
• Regularly identify and evaluate opportunities for improving clinical care, patient satisfaction, and efficiency in internal business processes, and recommend actionable changes.
• Oversees and leads process improvement efforts
• Create, implement, and monitor initiatives designed to meet the hospital's long-term quality and financial objectives.
• Maintain ongoing, proactive communication with payers and external parties to facilitate the timely and accurate completion of medical necessity reviews and appeals, and to resolve any issues that arise.
• Work collaboratively and communicate regularly with physicians and social services teams to coordinate all aspects of utilization management.

Requirements

A clinical degree in nursing, social work, psychology, or another related healthcare field is preferred.

Minimum of two (2) years of experience in a managed care environment.

Knowledge of inpatient and outpatient behavioral health clinical practice criteria preferred.

Proficient in Microsoft Office computer skills.

Knowledge of medical terminology.

Experience ensuring compliance within regulated timeframes.

Working knowledge of compliance with state & federal regulations

Strong, committed work ethic and dedication to achieving optimal results.

Strong leadership and communication skills.

Critical thinker and problem solver.

Highly motivated individual with the ability to work independently.

Excellent verbal and written communication skills.

Strong analytical, problem-solving, time management, and organizational skills.

Applicants must be at least 21 years old and qualify for an Arizona Fingerprint Clearance Card. Competitive compensation and benefits are offered. Aurora Behavioral Health System is an Equal Opportunity Employer.

Job Type : Full-time

Benefits :

401(k)

Dental insurance

Disability insurance

Employee assistance program

Employee discount

Flexible spending account

Health insurance

Health savings account

Life insurance

Paid time off

Professional development assistance

Vision insurance

Schedule :

Day shift

Monday to Friday

Education :

Master's (Preferred)

Experience :

Leadership : 2 years (Required)

Utilization management : 5 years (Required)

Work Location : In person

Must be able to pass a drug screen and physical

Must be eligible for a fingerprint clearance card