Utilization Review Director

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.
• ​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.