Director-Utilization Management

· 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.