Director of Utilization On-Site
Southwood Children's Behavioral Healthcare
Summary
Southwood Children's Behavioral Healthcare is seeking an experienced Director of Utilization to join our team. This is a 100% on-site position at our facility in Pittsburgh, Pennsylvania.
Job description
Overview
Southwood Children's Behavioral Healthcare is seeking an experienced Director of Utilization to join our team. This is a 100% on-site position at our facility in Pittsburgh, Pennsylvania.
Southwood Children's Behavioral Healthcare provides specialized behavioral health treatment for children and adolescents ages 3-21 facing emotional, behavioral, and psychiatric challenges, including inpatient, residential, partial hospitalization, and educational services.
Purpose Statement
Direct and manage the day-to-day operations of the Utilization Review department.
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 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
- Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
- Six or more years' 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.
- 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.
Requirements
- Bachelor's Degree in nursing or other clinical field required
- Master's Degree in clinical field preferred
- Six or more years' 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
- Current licensure as an LPN or RN within the state where the facility provides services, or current clinical professional license or certification as required
Benefits
- Medical, Dental & Vision
- HSA & FSA
- Basic Life & AD&D
- Disability Benefits
- 401(k) Matching
- EAP & Employee Discounts
- Paid Holidays
- Paid Time Off
- Tuition Reimbursement
Company overview
Southwood Children's Behavioral Healthcare is a specialized pediatric mental health organization dedicated to providing comprehensive behavioral healthcare services for children and adolescents. The organization focuses on addressing a wide range of mental health challenges including anxiety disorders, depression, behavioral issues, trauma-related conditions, and developmental disorders. Southwood employs evidence-based therapeutic approaches such as cognitive-behavioral therapy, play therapy, family therapy, and medication management when appropriate. Their multidisciplinary team typically includes child psychiatrists, psychologists, licensed clinical social workers, and behavioral specialists who work collaboratively to create individualized treatment plans. The organization emphasizes a holistic approach that considers the child's developmental stage, family dynamics, educational needs, and social environment. Southwood Children's Behavioral Healthcare plays a crucial role in early intervention and prevention, helping young patients develop healthy coping mechanisms and resilience while supporting families through the treatment process. Their services are designed to improve emotional regulation, social functioning, and overall quality of life for children facing mental health challenges.