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Director Utilization Review, RN

Company: Aurora Behavioral Health Care
Location: Pasadena
Posted on: June 14, 2018

Job Description:

Director of Utilization Review Management has 24 hour accountability for the oversight of all activities to manage the care of the patient over the continuum of care. These activities include admission, continued, extended and discharge reviews in all reimbursement categories to determine medical necessity, assure high quality of care and efficient utilization of available healthcare resources, facilities and services. Utilization Review Director coordinates and manages concurrent and retrospective reviews of all patient's medical records. Serves as the utilization liaison between hospital and Medical Staff. The individual in this position has overall responsibility for hospital utilization performance improvement, Denial Management, and operational management of the Utilization Review Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services. Manage denials to include reasons for denials, LOS impact, trending by Physician, insurances, and financial impact on A/R, and appeals Qualifications/Experience Minimum of two (2) years management experience. Experience in managed care environment required and Utilization Review. Experience in a California behavioral health preferred. Certification in Case Management preferred. Current California Nursing license, BLS, and CPI/MAB

Keywords: Aurora Behavioral Health Care, Pasadena, Director Utilization Review, RN, Executive, Pasadena, California

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