Utilization Review Director

Acadia Healthcare Fort Myers, FL
Job Description Overview

Park Royal Hospital has an opportunity for a Utilization Review Director.

Park Royal Hospital is a private free-standing 114-bed psychiatric hospital that provides life-changing care for adults 18 years and older and senior adults. Inpatient and outpatient treatment are provided for depression, anxiety, mood disorders, memory problems, post-traumatic stress disorder, and other mental illnesses as well as co-occurring substance abuse disorders.

Treatment is delivered by multi-disciplinary teams that include psychiatrists, social workers, therapists, primary care physicians, physical therapists, dietitians and 24-hour clinical and nursing staff, all working to support the patient in building a foundation for recovery.

Responsibilities

* Participates in pre-certifications for admissions with third party payers.

* Conduct admission review activities.

* Conducts continued stay review activities.

* Coordinates third party physician peer-to-peer reviews.

* Conducts discharge review activities.

* Notifies third party payers of discharge.

* Maintains accurate UR information and retrieves date for reports.

* Communicates results of third party reviews to appropriate staff for length of stay coordination and discharge planning.

* Establishes and maintains rapport with physicians to ensure adequate, accurate documentation of patient's care.

* Establishes and maintains rapport with clinical staff to ensure adequate, accurate, documentation of patient's care.

* Participate in treatment plan reviews.

* Performs concurrent and/or retrospective review/analysis for the appropriateness, effectiveness and efficiency of services.

* Acts as a resource to other staff on UR/third party requirements.

Job Requirements

* Bachelor's degree in Nursing or other clinical degree.

* At least 3 years' experience in Utilization Management/Review or Case Management.

* CPR, CPI, and First Aid required.

* Excellent interpersonal and writing skills.