Director of Utilization Review

Overview

Join StoneCrest Center, a 182-bed behavioral health hospital in Detroit, Michigan, dedicated to providing compassionate, evidence-based psychiatric care for adolescents, adults, and seniors. StoneCrest offers comprehensive inpatient treatment for a wide range of mental health and co-occurring substance use disorders, with specialized programming for adolescents, older adults, and individuals requiring acute crisis stabilization. The hospital's multidisciplinary approach includes psychiatry, nursing, case management, family therapy, recreational therapy, and other therapeutic services designed to help patients achieve lasting recovery and improved quality of life.

As the Director of Utilization Review, you will play a critical leadership role in ensuring the delivery of high-quality, medically necessary behavioral healthcare while optimizing patient outcomes and reimbursement processes. This is an opportunity to join a mission-driven organization where clinical excellence, collaboration, and patient-centered care are at the heart of everything we do.

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PURPOSE STATEMENT:

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

Responsibilities

​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.

​OTHER FUNCTIONS:

• ​Perform other functions and tasks as assigned.

Qualifications

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:

• ​If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

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