Group Director of Utilization Review

Who We Are:

Founded in 2001, Pasadena Villa has treated mental health conditions for all genders ages 18 and older, along with specialty residential programs for autistic clients.  Our customized and compassionate care is provided in a therapeutic environment that promotes well-being, recovery, and personal motivation.  There are multiple levels of care available at each of our Pasadena Villa locations, each providing the highest levels of care and support and the closest amount of supervision needed.

What We Offer:

• Collaborative environment dedicated to clinical excellence
• Multiple Career Development Pathways
• Company Supported Continuing Education & Certification
• PPO & HDHP Health Plan Options
• Flexible Dental & Vision Plan Options
• 100% Company Paid EAP Emotional Well-Being Support
• 100% Company Paid Critical Illness (with health enrollment plan)
• 100% Company Paid Life & ADD
• 401K with Company Match
• Company-Sponsored HSA, FSA, & DSA Tax Savings Accounts
• Generous Team Member Referral Program
• Parental Leave

How You Will Contribute:

The Group Director of Utilization Review is responsible for the overall management of the Utilization Review department by leading and facilitating review of assigned admissions, continued stays, utilization practices, and discharge planning according to approved clinically valid criteria.

Relationships and Contacts

Within the organization: Maintains frequent and close working relationships with the Network Leaders, Business Development team members, Admissions team members, Nursing leadership, milieu leadership, and all clinical team members.

Outside the organization: Initiates and maintains strong professional relationships with payor contacts.

Essential Responsibilities:

• Responsible for management, guidance, training, and leadership of Utilization Review staff and assist with difficult cases.
• Medical records review and ongoing training with all clinical/medical staff.
• Perform regular audits of Utilization Review staff’s work to ensure quality and performance.
• Maintains current knowledge of Utilization Review process, including denials and concurrent reviews.
• Revises processes as needed to meet organizational goals.
• Utilize effective documentation standards that support a strong historical record of actions taken on each account.
• Maintains a strict level of confidentiality for all company, departmental, and healthcare provider information.
• Reports challenges/roadblocks to management for resolution.

What We Are Seeking:

• Five years' experience with external review orga