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Recovery Centers of America at Danvers

Director of Admission & Utilization Review

Full-time Position

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Position Overview: Directs the admissions and utilization review management (UR) operations and staff for RCA. Serves as a point of contact for escalated utilization management decisions and works closely with Medical, Clinical and Primary Therapist teams. Ensures the admitting staff obtains necessary personal and financial data in determination patient’s eligibility for admission to an RCA facility. Develop processes and policies for admissions and utilization management that optimize patient outcomes and cost efficiency of services. Monitor utilization management decisions for quality, accuracy, and adherence to established criteria. Confirms that insurance benefit coverage meets standards of admissions.
 
Specific Responsibilities:
* Provides leadership and guidance to the Admissions and Utilization Review teams and their related caseloads and schedules.
* Provides reliable trending analysis of current and past data related to length of stay and days authorized by specific insurance companies.
* Collaborates closely with Medical team, Clinical team, and Primary Therapists to develop, implement, and evaluate the screening assessment, and admissions process, as well as the overall quality of the clinical program.
* Provides Admissions and UR teams with Recovery Centers of America training
* Strategic problem solving
* Follow all policies and procedures of Recovery Centers of America.
* Designs, establishes and maintains procedures and policies to ensue high bed occupancy and to control bed availability and patient traffic.
* Ensures compliance with accreditation agency requirements.
* Ensures compliance with the state requirements/guidelines.
* Represents UR staff and suggests solutions to identify problems.
* Ensures quality and quantity of documentation in medical records for UR.
* Attends treatment staff meetings.
* Knowledge of pre-assessment and pre-certification reviews and able to perform appeal reviews.
* Knowledge of discharge planning resources.
* Stays current with changes in State and Federal laws and regulations in areas of insurance/third party payers. Maintains professional and technical knowledge by attending educational workshops and conferences; reviews professional publications; establishes personal networks, participates in professional societies.
 
Education and Experience:
* Masters level Clinician plus 3 years’ experience preferred;
* Ability to work as a member of a management team.
* Knowledge of State and Federal Statutes regarding patient confidentiality laws.
* Knowledge of State guidelines and accreditation agency standards.
* Knowledge and experience of all continuums of care, including admission assessment and continued stay criteria
 
Competencies:
Leads and Engages staff: Articulates a vision that inspires others. Attracts, develops, and retains talent.
Decision making: Makes good decisions based on sound understanding and evaluation on relevant information; gathers information and involved others as appropriate.
Personal Effectiveness/Credibility: Ability to promise and deliver results, build effective relationships and establish a reliable track record.
Collaboration: Clinical leaders must be able to work in collaboration with other health professionals and leaders from other disciplines.
Customer Relationship Management: Engages customers interactively using technology, marketing, and customer services with the goal of improving business relationships with customers, assisting in customer retention and driving sales growth.
 
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients. 
 
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
 
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected

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