Job Information
Acadia Healthcare Utilization Review Director in Ball Ground, Georgia
Description
Blue Ridge Mountain Recovery Center has an opportunity in our detox/residential treatment center located in the beautiful North Georgia Mountains. This is an excellent opportunity for an individual to impact other human beings in such an AMAZING way that it changes their lives forever. We have a current position open for a Director of Utilization Review.
The Director of Utilization Review is an integral component of our multidisciplinary treatment team for substance abuse treatment. This position requires a thorough understanding of facility’s treatment program, philosophy and a strong working knowledge of various aspects of chemical dependency. The ideal candidate must demonstrate extensive knowledge of substance abuse treatment and utilization review procedures for various insurance companies.
Essential functions include but are not limited to:
Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the client’s provider benefits for their needs.
Communicate ALL daily UR activity effectively verbally and in writing with CEO, CFO, administration, clinical, nursing, business and UR staff about impending review issues.
Ensure UR information is updated, correct and current in multiple systems (accounting, daily census, etc.) in a timely manner.
Participate in monthly Acadia UR Director calls, management and leadership meetings and related training as required.
Manage denied care by preparing & documenting appeals, including leading and participating in monthly facility denial meetings.
Responsible for the concurrent and retrospective reviews for all clients.
Work with physicians, therapist and nursing staff to provide optimal review based on client needs.
Work with ancillary services in order to prevent delays in services.
May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
Provide oversight and direction to utilization staff.
Meets facility and regulatory training requirements by attending all mandatory staff meetings and training sessions as required.
Benefits:
Health and welfare benefits including, medical, dental, vision, STD, LTD, life insurance.
401k program
Paid vacation, sick, vacation and holidays
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred. (RN and LPN preferred.)
Six or more year's 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.
Qualifications
Skills
Preferred
Leadership: Novice
Communication: Novice
Attention to Detail: Novice
Behaviors
Preferred
Team Player: Works well as a member of a group
Leader: Inspires teammates to follow them
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Dedicated: Devoted to a task or purpose with loyalty or integrity
Motivations
Preferred
Self-Starter: Inspired to perform without outside help
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Experience
Required
2-3 years: Supervisory and/or management
2-3 years: Substance abuse treatment field with previous experience in utilization management
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
