Bourne, MA
Full-time


GOSNOLD

Gosnold’s mission is to excel in addiction and mental health treatment, to serve men, women, and families affected by these illnesses and to promote lasting recovery.

**Gosnold will be hosting Walk-In Job Fairs, every Tuesday from 11-1pm at 200 Ter Heun Drive in Falmouth. We have openings for various positions and locations including Recovery Aides, Kitchen Staff, Housekeepers, Custodians, Nurses, Clinicians and more. Refreshments will be provided. Stop by for an on the spot interview, no appointment necessary! Gosnold is an Equal Opportunity Employer.

We are hiring: DIRECTOR of UTILIZATION MANAGEMENT

QUALIFICATIONS

  • Master’s degree required: social work, counseling, psychology, RN or similar related health discipline.
  • 4 years’ experience conducting utilization review or clinical assessments in behavioral health, dual diagnosis or managed care setting.
  • Ability to lead and direct a team. Supervisory experience strongly preferred.
  • Knowledge of behavioral health admissions and payer coverage criteria.
  • Working knowledge of behavioral health contracts and experience with health care contracting entities.
  • Ability to communicate effectively and work cooperatively with the public, health care professions, utilization management personnel, referral agencies and Gosnold admissions and patient accounts staff.
  • Excellent computer skills.

RESPONSIBILITIES:

  • Manage the day-to-day operations of the Utilization Department.
  • Monitor all new inpatient admissions to insure coverage is in place.
  • Communicate pre-certification/initial authorization problems to Patient Financial Services daily.
  • Notify Patient Financial Services when patient’s insurance coverage is in question.
  • Daily monitoring of authorizations and concurrent reviews.
  • Ensure authorizations are correct in Evolve (EMR).
  • Assist staff as necessary with authorization data entry.
  • Research authorization letters and reconcile to authorization information in EMR.
  • Assure prompt resolution of authorization discrepancies.
  • Monitor and coordinate appeal process.
  • Prompt communication to Patient Financial Services regarding covered days and appeal status.
  • Assist with case preparation for doctor-to-doctor reviews.
  • Prepare records to send in for review.
  • Assist Utilization Review staff with appeal cover letters.
  • Follow appeal process through resolution.
  • Ensure that appeal status is documented in appropriate EMR authorization notes.
  • Manage UR team:
  • Manage staff schedule, payroll, time off requests and performance evaluations.
  • Consult with clinical staff to coordinate recommendations for intervention strategies and authorizations for continued care.
  • Provide technical assistance to staff with care coordination activities as needed.
  • Identify process or systemic issues and recommend, develop, and implement quality improvement plans.
  • Perform other related duties as assigned.

The Director of Utilization Management reports directly to the Chief Clinical Officer

Benefits

Gosnold offers a comprehensive benefits program including medical, dental, vision, 403b Retirement including an employer match, Short term disability, Life Insurance, Supplemental Life Insurance, Tuition Assistance Program, Flexible Spending Accounts, Direct Deposit, Personal Home Owners, Automobile, and Umbrella available through a payroll deduction, Critical Illness and Accident Insurance, Employee Assistance Program, Paid Vacation Time, Paid Sick Leave and Paid Holidays.

Please see the Summary of Benefits for specifics

Req. 1108

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