About Center For Discovery
Center For Discovery has a 20-year legacy of transforming lives by promoting health, healing and hope to our clients and their families. We are a national leader in behavioral healthcare and offer world-class treatment for eating disorders, mental health and substance abuse conditions. We serve adolescents and adults in both residential and outpatient settings. It is our mission to create a transformative therapeutic experience aimed at profoundly and creatively facilitating behavioral, emotional and spiritual growth. We place a high priority on providing an environment that supports an unlimited capacity for learning, and we seek qualified individuals who share our passion for improving the lives of those we serve.
The Director of Utilization Review coordinates all aspects of the company’s utilization review process to ensure that every patient receives quality care through utilization of adequate resources in the most cost-effective manner. The Director serves as the utilization liaison between treatment team and different payers. The individual in this position has overall responsibility for utilization performance improvement, denied authorizations, and operational management of the Utilization Review Department in order to promote effective utilization of resources. The position entails coordinating and managing concurrent and retrospective reviews of all patient’s medical records over the continuum of care.
The Director of Utilization Review works closely with the physicians, nursing and clinical departments to ensure quality of documentation of patient care. The Director implements and manages the Utilization Management Plan and identifies trends that impact service delivery for quality improvement. The Director manages admission, concurrent and peer review as well as denials and appeals. The Director ensures cases are reviewed and responded to in a timely and clinically sound manner in accordance with policies and procedures. The Director implements and manages the Utilization Management Plan and identifies trends which impact service delivery for quality improvement including reasons for denials at a certain LOC, LOS impact, trending by Physician, insurances, financial impact, and appeals.