Acadia Healthcare
Director Of Utilization
Tufts Medicine Behavioral Health Hospital
Tufts Medicine, a leading integrated academic health system in Massachusetts, and Acadia Healthcare, the largest standalone provider of behavioral health services in the U.S., have partnered to create the Tufts Medicine Behavioral Health Hospital, a state-of-the-art, 144-bed facility in Malden, Massachusetts. Slated to open in fall 2025, this hospital is designed to address the growing need for high-quality behavioral health services in the region. The Tufts Medicine Behavioral Health Hospital will serve as a center of excellence, offering inpatient and intensive outpatient programs for patients of all ages. Additionally, it will function as a teaching hospital, providing a vital training site for future behavioral health professionals, including students and residents from the Tufts University School of Medicine. This initiative aims to address the regional shortage of behavioral health clinicians while ensuring a continuum of care for patients and their families. The Director Of Utilization will direct and manage the day-to-day operations of the Utilization Review department. 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. Collaborate with physicians, therapist, and nursing staff to provide optimal review based on patient needs. Collaborate 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 including hiring, development, training, performance management, and communication to ensure effective and efficient department operation. Other Functions:
Perform other functions and tasks as assigned. Education/Experience/Skill Requirements:
Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred. Six or more years' 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.
Tufts Medicine Behavioral Health Hospital
Tufts Medicine, a leading integrated academic health system in Massachusetts, and Acadia Healthcare, the largest standalone provider of behavioral health services in the U.S., have partnered to create the Tufts Medicine Behavioral Health Hospital, a state-of-the-art, 144-bed facility in Malden, Massachusetts. Slated to open in fall 2025, this hospital is designed to address the growing need for high-quality behavioral health services in the region. The Tufts Medicine Behavioral Health Hospital will serve as a center of excellence, offering inpatient and intensive outpatient programs for patients of all ages. Additionally, it will function as a teaching hospital, providing a vital training site for future behavioral health professionals, including students and residents from the Tufts University School of Medicine. This initiative aims to address the regional shortage of behavioral health clinicians while ensuring a continuum of care for patients and their families. The Director Of Utilization will direct and manage the day-to-day operations of the Utilization Review department. 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. Collaborate with physicians, therapist, and nursing staff to provide optimal review based on patient needs. Collaborate 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 including hiring, development, training, performance management, and communication to ensure effective and efficient department operation. Other Functions:
Perform other functions and tasks as assigned. Education/Experience/Skill Requirements:
Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred. Six or more years' 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.