Director of Utilization Review in Chattanooga, TN at Acadia Healthcare

Date Posted: 6/16/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Experience:
    3 to 5 years
  • Date Posted:
    6/16/2018

Job Description

Overview

    Erlanger Behavioral Health Hospital

Utilization Review Director

Erlanger and Acadia Healthcare have joined to develope Erlanger’s new Behavioral Health Hospital to open May of 2018.

This 88-bed hospital is a joint effort between Erlanger and Acadia Healthcare, which owns the nation’s largest network of mental health facilities.

The two-story, 69,000-square foot facility is being built on the corner of North Holtzclaw and Citico Avenues. It will include 24 beds for geriatric patients, 24 for adults, 18 for children and adolescents, and 22 for substance abuse patients. 

Responsibilities
  • Manages and performs utilization reviews to ensure adherence to federal regulations. 
  • Assist in maintaining records, answering correspondence and preparing and disseminating reports. 
  • Familiar with standard concepts, practices, and procedures within related field. 
  • Organizes and conducts the managed care process.  This includes conducting admission and continued stay record reviews; utilizing approved criteria; making determinations of medical necessity active treatment; assisting in the discharge planning process; acting as liaison with third party payers/managed care companies and interacting in the managed care process. 
  • Familiarity with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping; strong interpersonal organizational, evaluative, and time management skills; policy interpretation skills, familiarity with applicable standards and regulations; ability to comprehend psychiatric evaluations, consults, etc.
  • Discuss clinical review audits.
  • Work closely with Psychiatrist, DON, and Clinical Director.
  • Use and understand DSM IV.
  • Excellent follow-through.
  • Formulate documents to meet standards.
  • Ability to multi-task, capable of daily problem-solving complex issues.
  • Records maintenance.
  • Ability to plan, implement, and evaluate individual patient care programs.
  • Knowledge of state and federal regulation governing medical service utilization. Ability to interpret and apply state and federal laws, regulations, and policies governing utilization review.
  • Knowledge of case management, health record review, and monitoring procedures.
  • Prepare, present, and review oral and written information and detailed reports.
  • Review and verity utilization compliance and determine corrective action.

Job Requirements

  • Bachelor’s Degree with 3-5 years psychiatric experience, RN, or LPN with 3-5 years psychiatric experience. Master’s Degree preferred.
  • Possess strong clinical background with specialization in clinical theories pertinent to MR/DD-MI children, adolescents, and residential treatment.

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