Director-Utilization Management

Come join our team as a Utilization Management Director at River Place Behavioral Health! If you are a positive, empathetic, and passionate person and are dedicated to making a difference in the lives of those in need while working in a team environment that supports learning and growth, this position is right for you!

River Place Behavioral Health, a service of Ochsner Health System, provides state-of-the-art psychiatric care for adults who are struggling with depression, anxiety, bipolar disorder, and other mental health concerns. 

PURPOSE STATEMENT:

Direct and manage the day-to-day operations of the Utilization Review department.

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.

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.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• Current licensure as an LPN or RN or current clinical professional license or certification in the state of LA.