Director of Utilization

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.​

At Southwood Children’s Behavioral Healthcare, we are dedicated to providing specialized behavioral health treatment for children and adolescents ages 3-21 facing emotional, behavioral, and psychiatric challenges. Located in the Pittsburgh area, Southwood offers a comprehensive continuum of care designed to meet the unique needs of youth and their families, including inpatient, residential, partial hospitalization, and educational services.

Southwood Children's Behavioral Healthcare offers an extensive array of benefits to our valued team members. Current offerings encompass: 

• Medical, Dental, and Vision Insurance coverage
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options
• Company-paid Basic Life & AD&D insurance
• Disability benefits
• 401(k) Retirement Plan with a company match
• Employee Assistance Program (EAP) and Employee Discount Program
• Paid Holidays for work-life balance
• Paid Time Off (PTO) 
• Tuition Reimbursement opportunities for career advancement 

PURPOSE STATEMENT: 

​Direct and manage the day-to-day operations of the Utilization Review department. 

Responsibilities

​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 to 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

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

• ​Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.  
• ​Six or more year's 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. 

​LICENSES/DESIGNATIONS/CERTIFICATIONS:  

• ​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. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

AHCORP

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