Associate Director of Utilization Review

As the Associate Director of Utilization Review, you’ll play a key role in making sure our patients receive the best care possible while navigating the often complex world of insurance and authorizations. Leading a dynamic team of remote Utilization Review Specialists, you’ll collaborate closely with our clinical leadership to develop strategies that ensure seamless care and coverage. You’ll also drive the development of policies, procedures, and best practices, while making sure we stay ahead of ever-evolving payer requirements. Creating a culture that champions patient advocacy will be at the heart of everything you do, and you'll be the go-to person for fostering strong relationships with our payer partners. From tackling denials and appeals to optimizing utilization rates, you'll be at the helm of improving key performance indicators that directly impact our patients and the organization. If you’re passionate about both patient care and operational excellence, you’d be a great addition to our team!

What You’ll Do:

• Manage and lead the Utilization Review staff 
• Create a culture of patient advocacy
• Develop, implement, and improve policies, procedures and standard work for utilization review functions
• On daily basis, ensure all patients have appropriate documented insurance authorizations in place through staff completing pre-certifications, concurrent reviews, peer reviews and/or appeals
• Coordinate patient/family communication when authorization status changes and/or coverage is in jeopardy
• Ensure compliance with payor authorization procedures and requirements
• Participate and lead, as necessary, case conferences to help treatment teams, clinical leadership, and patients navigate denials and/or lapses in authorization and/or benefit coverage
• Develop clear communication channels with site leaders related to levels of care transitions, patient attendance, and documentation
• Conduct regular audits and reviews to monitor the effectiveness of utilization management processes
• Analyze date to identify trends and opportunities for improvement
• Provide training and development opportunities for staff
• Maintain up to date knowledge of payor specific standards, industry standards and best practices
• Work closely with revenue cycle personnel to resolve billing/claims/payment issues involving authorizations
• Facilitate opportunities for Compass clinical leaders and/or payor relations to meet with payors to provide information about our services and/or programming

Who You Are:

• Strong knowledge of Microsoft Office products (Word, Excel, Access, PowerPoint, etc.) 
• Strong interpersonal and leadership skills  
• Strong verbal and written communication skills to lead a remote team working across the country
• Highly organized, effective in time management, ability to manage multiple priorities, strong teamwork skills 
• Strong knowledge of behavioral health medical necessity criteria and level of care guidelines
• Minimum of five years’ experience in utilization review or case management within a behavioral health or substance abuse setting
• Bachelor’s degree in behavioral health, healthcare administration, or a related field; advanced degree preferred
• Minimum of 3 years management or leadership experience required