Director-Utilization Management

Come join our team as the Utilization Review Director at The Refuge, a Healing Place! 

Schedule will be Monday - Friday.  Some evening, weekend and holidays may be required.

We offer a full suite of benefits ranging from:

• Medical, Dental, and Vision Insurance
• 8 paid annual holidays
• Paid time off
• HSA & FSA
• Company Paid Basic Life & AD&D
• Short term and long term disability
• 401(k) Retirement Plan with company match
• Employee Assistance Program and Employee Discounts

At The Refuge, a Healing Place, we specialize in unraveling the trauma story, understanding the addiction/mental health disorder and creating a recovery story! We are a residential treatment center specializing in trauma treatment, substance use disorders, eating disorders, PTSD, and other mental health disorders.

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.

Job Requirements

• Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
• Six or more years' clinical experience in behavioral health
• Four or more years’ experience in utilization management required.   
• Three or more years of supervisory experience required.
• Clinical licensure strongly preferred (LMHC, LCSW, LMFT)