The Director of Utilization Review coordinates all aspects of the hospital's utilization review process to ensure that every patient receives quality care through utilization of adequate resources in the most cost-effective manner. The Director also performs admission and concurrent reviews of patients and assures optimum quality of care as part of treatment teams. The Director works closely with the physicians, nursing and the social services departments to ensure quality of documentation of patient care. The Director implements and manages the Utilization Management Plan and identifies trends which impact service delivery for quality improvement. The Director manages admission, concurrent and peer review as well as denials and appeals. The Director assures adherence to Accrediting and Regulatory Agency Requirements maintaining records to ensure compliance.
The Director of Utilization Review is responsible for supervising staff that analyzes patient records to determine legitimacy of admission, treatment, and length of stay in inpatient behavior health setting to comply with government and insurance company reimbursement policies. Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients. Must be able to maintain composure under stressful situations while upholding facility mission and vision.
The Director may be assigned other duties by the CFO and/or CEO.