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Director of Utilization Management

Monte Nido

Remote

Monte Nido has been delivering treatment for eating disorders for over two decades.Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

We are looking for a Director of Utilization Management to oversee the Utilization Management/Review team and function. This role with report to the SVP of Operations.

\#LI-REMOTE

Total Rewards:

Discover a rewarding career with us and enjoy an array of comprehensive benefits! We prioritize your success and well-being, providing:

+ Competitive compensation

+ Medical, dental, and vision insurance coverage (Benefits At a Glance (https://montenidoaffiliates.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=2025&hashed=-1683222091) )

+ Retirement

+ Company-paid life insurance, AD&D, and short-term disability

+ Employee Assistance Program (EAP)

+ Flexible Spending Account (FSA)

+ Health Savings Account (HSA)

+ Paid time off

+ Professional development

+ And many more!

We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Responsibilities Include:

+ Assess UR staffing needs and develop UR structure at the company-level (in partnership with company leadership.

+ Managedepartmentstaff,includingHR-related manager responsibilities(hiring,supervising,monitoring,promoting,terminations, etc.) in collaboration with the HR and Talent teams.Collaborate in the develop and implementation of policies and procedures for completing UR.

+ Implement,maintaina standardized clinical documentation acrossprograms.

+ Make recommendations for operational or clinical strategies to improve URoutcomes.

+ Train all UR staff on utilization reviewtechniques.

+ Provide case consultation on conceptualizing and presenting URcases.

+ Administeraudits toensurecompliancewithpayerrequirements(inpartnership withCompliance department) and make recommendations to leadership team to improvecompliance.

+ Lead, organize, and direct insurance-initiated audits.

+ Identify and communicate emerging trends with insurancecompanies.

+ Partner with internal stakeholders and outside vendor partners to ensure an effective UR process that is integrated across Admissions and Finance functions (e.g., Billing & Collections team).

+ MaintaindatabaseofmedicalnecessitycriteriaandothernecessarydocumentsandclinicalammunitiontosupportUR process.

+ Communicate with payers on an as-needed basis.

+ Communicate and solve problems via chain ofcommand.

+ Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staffdiversity.

+ Maintain acceptable overallattendance.

+ Promote a favorable/positive work atmosphere.

+ Attend in-services and educational training as necessary and asassigned.

+ Seek out learning experiences and incorporate new knowledge intopractice.

+ Maintain flexibility and adaptability to expected and unexpected changes in the workenvironment.

+ Report incidents, accidents and occurrences in accordance with policies andprocedures.

+ Maintain safety of the physicalenvironment.

+ Comply with facility policies andprocedures.

Qualifications:

+ Graduation from an accredited college or university with a minimum of a Bachelor’s Degree in Mental Health, Public Health, Social Work, Business Administration, Nursing or related field. Master’s Degree preferred.

+ Previous utilization management experience in a behavioral healthcare facility preferred, knowledge of Joint Commission compliance strongly preferred

+ Current unencumbered clinical license and valid driver's license

\#montenidoaffiliates