Utilization Review Director – Aliso Ridge Behavioral Health – Aliso Viejo, CA

POSITION TITLE: Utilization Review Director

REPORTS TO (TITLE): Chief Financial Officer

EMPLOYEE PAY STATUS: Exempt

DESCRIPTION OF POSITION:

UR Director conducts a review of patients’ statistical information related to utilization review, collects data that profiles that appropriateness and quality of patient care and is a resource to the medical staff with regard to case management.

KEY RESPONSIBILITIES:

· Ensures timely pre-certification an re-certification of patients medical necessity with review organizations and third party payers.

· Provides immediate notification of denial of certification to business office/administration and attending physicians.

· Protects the confidentiality of the patients record and the hospitals liability when releasing information to third party payers and review organizations.

· Maintains a good rapport and a cooperative working relationship with physicians, departments and staff.

Minimum Requirements:

Education and Licensing:

· Bachelor’s degree in related healthcare field required. Master’s degree preferred.

Knowledge and Experience:

·Three years minimum experience in utilization review or related field, five years or more preferred.

Previous supervisory experience preferred.

Proficient knowledge of and success in dealing with acute and managed care environment in the mental health field.

· Ability to prioritize and work with minimal supervision.

· Highly organized with detail and results orientation.

· Excellent communication skills, both written and verbal.

· Ability to deal with all levels of stress and handle crises situations.

Skills and Abilities:

· Maintains confidentiality of patients at all times.

· Ability to cope well with stress and have a strong sense of compassion.

· Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.

· Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).

· Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.

· Strong written and verbal communication skills.

· Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.

· Ability to work independently and as part of a team.

· Good judgment, problem-solving and decision-making skills.

· Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others.

· Ability to work in a fast-paced, expanding organization.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Medical Specialty:

• Psychiatry

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Aliso Viejo, CA 92656: Reliably commute or planning to relocate before starting work (Preferred)

Education:

• Bachelor’s (Required)

Experience:

• Utilization review: 3 years (Required)

Work Location: One location