Utilization Review/Case Management Director

Provide utilization review/case management services by coordination with managed care agencies and hospitals.  Interfaces with Treatment Team and reviews clinical information with hospitals and managed care agencies for requested lengths of stay and levels of care.

ESSENTIAL FUNCTIONS:

Provide guidance and interpretation of medical necessity criteria in admissions and level of care decisions.  Concurrent review of criteria to approve ongoing length of stays at hospitals and outpatient services.

As a part of the facility’s Management Team, participates in developing and maintaining policies and procedures, facilitating managed care contracts and developing professional relationships.

MINIMUM JOB REQUIREMENTS:

Education/Experience:  LCSW, MFT, PhD, or RN with 5+ years experience in mental health/substance abuse profession.  Medical terminology.  Knowledge of the DSM, multi-axial system.  Computer skills.

Specific Skills:  Organizational and communication skills, working knowledge of Milliman and ASAM criteria.

Harmony Healthcare is an equal opportunity employer