Valley Behavioral Health

Director of Utilization

Valley Behavioral Health • $90K — $120K *
El Paso, TX 79936In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in nursing or related clinical field required; Master's Degree preferred.
  • Over six years of clinical experience with the facility's patient population.
  • Minimum of four years' experience in utilization management required.
  • At least three years of supervisory experience required.
  • Current licensure as an LPN or RN within the relevant state or applicable clinical certification.

Responsibilities

  • Monitor service utilization and enhance reimbursement for the facility.
  • Conduct and oversee concurrent and retrospective patient reviews.
  • Serve as a liaison between Medicaid reviewers and staff for documentation needs.
  • Collaborate with physicians and nursing staff to ensure patient-centered reviews.
  • Work with ancillary services to prevent delays in care deliveries.
  • Evaluate the Utilization Management program for regulatory compliance.
  • Review patient charts and provide recommendations on managed care issues.

Benefits

  • Comprehensive training and development opportunities.
  • Supportive organizational culture focused on patient care.
  • Collaboration with multidisciplinary teams for improved patient outcomes.
Full Job Description
Overview

PURPOSE STATEMENT:

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

Responsibilities

ESSENTIAL FUNCTIONS:
  • 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.
  • 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.


Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
  • Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field 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.

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 required, within the state where the facility provides services.

About Valley Behavioral Health

Valley Behavioral Health is a non-profit organization that provides mental health and substance abuse treatment services to individuals and families in Utah. The organization was founded in 1989 and has since grown to become one of the largest providers of behavioral health services in the state. Valley Behavioral Health offers a wide range of services, including outpatient therapy, medication management, crisis intervention, and residential treatment. The organization is committed to providing high-quality, evidence-based care to its clients and to promoting mental health awareness and education in the community.
Learn more about Valley Behavioral Health
Size
1,000 employees
Industry
Healthcare
Founded
1987
* Ladders Estimates

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