Director of Utilization Review Fulltime

The team at Houston Behavioral Healthcare Hospital strives to be the leaders in Behavioral Health by delivering quality services to those entrusted in our care. By embarking on a path with our community and ensure Compassion, Acceptance, Respect, Empowerment, and Sincerity. One team, one goal are steps Houston Behavioral Healthcare will take together to improve the well being of our customers. Currently Houston Behavioral Healthcare Hospital (HBHH) is recruiting for a Utilization Review Director. The UR Director will report directly to the CFO and will oversee the UR Department.

The UR Director will be responsible for overseeing the inpatient and outpatient services, this includes case management processes, consulting with all services to ensure the provision of an effective treatment plan for all patients. This person will oversee the response to request for services and interface with managed care organization, external reviewers and other payors.

Our ideal candidate will facilitate the timely coordination of quality health care service reviews to advocate for authorization of patient specific healthcare needs in a cost effective manner to promote positive outcomes. Contacts external case managers/managed care organizations for certification and re-certification of insurance benefits throughout the patient’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.

Duties also include:

• Required to attend flash meeting daily at 9:30 am to report updates.
• A report of authorization days updated daily.
• A low target of denial percentages.
• Manage targeted population of daily census.
• Is responsible for the Utilization Management Committee quarterly.
• Assess adequacy of discharge clinicals, sent to various insurance companies.

Requirements

Experience: A minimum of five (5) clinical years experience in a healthcare or mental health setting, Including one year of management and related function preferred.

Experience and patient assessment, family motivation, treatment planning, and communication with external review organization or comparable entities. Degree in nursing, social work, mental health or behavioral health sciences or related field, preferred.

Benefits

Medical,

Dental,

Vision,

STD, & LTD,

Paid Time Off

Retirement plan (401k)