RTTEMPS/RNTEMPS – Director of Utilization Management

HOT FILL ASAP for a Utilization review Registered Nurse in Virginia; it is a 13 week contract that could also become a permanent position.
TITLE:  Director of Utilization Management

SUMMARY:
This position is responsible for conducting and arranging clinical care reviews for clients in all of the fee for services programs.   The person in this position obtains funding authorizations from the client’s insurance provider, discussing with clients and their families other potential funding options, including self-pay, Medicaid, and jurisdictions.  The person will also aid the primary Counselor in discharge planning for the Insurance/self-pay clients.  The person in this position operates under the Supervision of the Clinical Director and the Regional Director.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Conduct concurrent clinical reviews with 3rd party payers as required to increase a client’s length of stay
Advocate for necessary treatment stays for our clients with insurance case manager
Gather progress information in order to conduct reviews with Primary counselors, nurse, doctors and residential staff
Team with staff to increase LOS for clients thus improving chances of ongoing sobriety
Assist clients and/or their families or referral sources in identifying, verifying, and arranging alternative funding once insurance is exhausted
Establish thorough understanding of the various funding alternatives available to clients and how these are accessed
Refer clients to appropriate agencies that could help with funding, including CSBs, church, CSA etc.
Assist clients in understanding insurance benefits or funding information from insurance companies, state funding sources, or other sources
Document all funding information obtained and provides all billing information needed to Fiscal Department
Assist primary counselors with discharge planning
Identify discharge placement that are acceptable for on-going care for insurance clients
Provide discharge options to clinical team, clients and their families to aid in discharge planning
Assist clients in maximizing their resources in order to get the optimum treatment experience
Maintain ethical standards and continued professional growth, including:
Abide by Program and Client policy and procedures.
Ensure all CARF standards are instituted and maintained.
Promote, in public and private contacts, the quality standards and ethical practices of Client staff.
Continue professional growth by attending workshops, trainings and staff in-service trainings to increase skill and knowledge and to set appropriate example for staff
Maintain professional boundaries with staff and clients
Perform other duties as assigned by supervisor.

QUALIFICATIONS:
Must be currently licensed in the Commonwealth of Virginia or Compact
Five (5) years of experience in a substance abuse or mental health treatment setting or marketing setting or in a closely related field
Three to five years’ experience in directing utilization management and discharge planning

KNOWLEDGE AND SKILLS:
Knowledgeable of the medical aspects of addiction, including dual diagnosis, and must have excellent assessment skills
Ability to prioritize multiple assignments while meeting rigid deadlines
Exceptional analytical skills
Exceptional Customer Service skills
Exceptional organization skills
Skill in implementing nursing protocol
Skill in patient assessment
Ability to carry out instruction and accurately document medical information.
Ability to apply organizational management skills and maintain self and resident discipline
Ability to comply with state and federal regulations regarding confidentiality
Computer literate; demonstrated proficiency in Microsoft Office and web-based applications

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.  In the course of performing this job, one typically spends time sitting, walking, standing, carrying, and climbing stairs, lifting up to 15 pounds, listening, speaking, typing, reading, and writing.

Interested candidates please send resume to: denise@rttemps.com.