Director of Utilization Review

Vista del Mar Hospital
Ventura, CA
Job Description
This Director of Utilization Review will manage and coordinate the utilization review process, assess medical appropriateness, and ensure the organization provides appropriate and value-based care. They'll be responsible for gathering and communicating information to clinical and payor teams, ensuring benefits compliance, and providing patient assurance of healthcare services. The role requires collaboration with clinical teams and insurance benefit specialists.

Requirements

  • Bachelor's Degree in Nursing preferred, or equivalent combination of education and experience.
  • At least (3) years of direct clinical experience in psychiatric or behavioral health treatment setting.
  • Outpatient clinical experience highly desirable.
  • Utilization Management/UR or insurance case management experience and familiarity with insurance benefit language required.

Benefits

  • Health Insurance
  • Dental Insurance
  • 401(k)
  • Employee Assistance Program
  • Flexible Spending Account
  • Life Insurance
  • Vision Insurance
  • Medical Specialties: Psychiatry
  • Paid time off
  • Discounted Cafeteria Meal Plan
  • Short and Long Term Disability
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